Organization
SPENCER A. ELLIS
Active
Other names
Ellis Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SPENCER A. ELLIS D.D.S. (OWNER)
(423) 663-4444
Entity
Organization
Contact information
Practice address
170 SCOTT HIGH DR, HUNTSVILLE, TN 37756-4152
(423) 663-4444
(423) 663-4439
Mailing address
PO BOX 209, HUNTSVILLE, TN 37756-0209
(423) 663-4444
(423) 663-4439
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS7646
TN
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3139906
BLUE CROSS BLUE SHEILD
TN
Enumeration date
01/07/2008
Last updated
10/02/2023
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