Individual
DR. MARK ALLEN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
910 AVERITT RD, GREENWOOD, IN 46143-9540
(317) 859-9450
(317) 859-9475
Mailing address
910 AVERITT RD, GREENWOOD, IN 46143-9540
(317) 859-9450
(317) 859-9475
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12010547A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200500300
—
IN
Enumeration date
10/04/2006
Last updated
12/13/2018
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