Organization
FAMILY AND COSMETIC DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY RAY ELLIS DDS (PRESIDENT)
(402) 334-8208
Entity
Organization
Contact information
Practice address
11836 ELM STREET, SUITE 1, OMAHA, NE 68144-4439
(402) 334-8208
(402) 334-1106
Mailing address
12518 A STREET, OMAHA, NE 68144-4137
(402) 330-8216
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/06/2006
Last updated
08/01/2012
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