Individual
ROBERT ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 HARBOR TOWN SQ STE 203, MEMPHIS, TN 38103-8890
(901) 453-6081
Mailing address
279 QUINN RD, COLLIERVILLE, TN 38017-3004
(770) 714-4233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10785
TN
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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