Individual
DR. STACY BRIAN ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2831 S HURSTBOURNE PKWY, LOUISVILLE, KY 40220-4112
(502) 491-0330
(502) 491-7431
Mailing address
2831 S HURSTBOURNE PKWY, LOUISVILLE, KY 40220-4112
(502) 491-0330
(502) 491-7431
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5989
KY
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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