Individual
TERRY RANDAL ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1244 AUGUSTA WEST PARKWAY, AUGUSTA, GA 30909
(706) 855-7220
(706) 855-7260
Mailing address
1244 AUGUSTA WEST PARKWAY, AUGUSTA, GA 30909
(706) 855-7220
(706) 855-7260
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
254190
MS
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN011393
GA
Other
Enumeration date
02/24/2006
Last updated
07/08/2007
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