Individual
MARK A ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
425 7TH ST NW, CASS LAKE, MN 56633-3360
(218) 335-3230
Mailing address
425 7TH ST NW, CASS LAKE, MN 56633-3360
(218) 335-3230
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0025030
TX
Other
Enumeration date
09/24/2009
Last updated
10/26/2009
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