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Individual

DR. SCOTT BRADLEY ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
23520 OVERLAND DR STE 134, DULLES, VA 20166-2197
(703) 661-3360
(703) 661-3363
Mailing address
23520 OVERLAND DR STE 134, DULLES, VA 20166-2197
(703) 661-3360
(703) 661-3363

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401411747
VA

Other

Enumeration date
10/13/2009
Last updated
10/13/2009
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