Organization
PROGRESSIVE ORTHODONTICS, PLLC
Active
Organization
PROGRESSIVE ORTHODONTICS, PLLC
Active
Parent organization
PROGRESSIVE ORTHODONTICS, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROGRESSIVE ORTHODONTICS, PLLC
Authorized official
DR. TIMOTHY M. ELLIS DMD, MS, PA (PATNER/OWNER)
(863) 533-3302
Entity
Organization
Contact information
Practice address
2110 E. FLAMINGO DR., BARTOW, FL 33830-4236
(863) 533-3302
(863) 534-3818
Mailing address
2110 E. FLAMINGO DR., BARTOW, FL 33830-4236
(863) 533-3302
(863) 534-3818
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN10745
FL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DN16931
FL
Other
Enumeration date
01/20/2010
Last updated
01/20/2010
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