Individual
DR. DIANA HWEI-ANN JAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
500 N JACKSON ST, JACKSON, MI 49201-1223
(517) 748-5500
(517) 780-9286
Mailing address
505 N JACKSON ST, JACKSON, MI 49201-1266
(517) 748-5500
(517) 780-9286
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DJ018840
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
744718389
—
MI
01
—
88131
DELTA DENTAL PROVIDER NUM
MI
01
—
D801057
BCBS PROVIDER NUMBER
MI
Enumeration date
10/02/2006
Last updated
07/21/2022
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