Individual
DR. JAMES W ELLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DR
Contact information
Practice address
126 POPLAR GROVE CONNECTOR, 126 POPLAR GROVE CONNECTOR, BOONE, NC 28607-5915
(828) 264-4995
(828) 264-4997
Mailing address
126 POPLAR GROVE CONNECTOR, BOONE, NC 28607-5915
(828) 264-4995
(828) 264-4997
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3875
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0709B
BLUE CROSS
NC
01
—
0709K
BLUE CROSS
NC
01
—
0709W
BLUE CROSS
NC
05
—
3404303
—
NC
05
—
3404305
—
NC
05
—
3404395
—
NC
05
—
3404485
—
NC
Enumeration date
05/08/2007
Last updated
07/08/2007
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