Individual
RANDAL W ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD P.L.L.C
Contact information
Practice address
3739 MT BAKER HWY, EVERSON, WA 98247-9406
(360) 592-1100
(360) 592-5067
Mailing address
PO BOX 608, DEMING, WA 98244-0608
(360) 592-1100
(360) 592-5067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
00008470
WA
Other
Enumeration date
05/02/2012
Last updated
05/03/2012
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