Individual
DR. ROBERT STEPHEN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1434 - PARKER DRIVE, LAUREL, MS 39440-1942
(601) 649-3335
(601) 426-6318
Mailing address
1434 - PARKER DRIVE, LAUREL, MS 39440-1942
(601) 649-3335
(601) 426-6318
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1711-76
MS
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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