Individual
ERIC EDWARD ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
31307 N 137TH AVE, PEORIA, AZ 85383-7941
(586) 322-9041
Mailing address
31307 N 137TH AVE, PEORIA, AZ 85383-7941
(586) 322-9041
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901019386
MI
1223P0221X
Pediatric Dentistry
2901019386
MI
1223P0221X
Pediatric Dentistry
Primary
7708
AZ
Other
Enumeration date
08/01/2008
Last updated
11/09/2010
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