Individual
STEVEN L. ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
155 SACO AVE, OLD ORCHARD BEACH, ME 04064-1600
(207) 934-5411
Mailing address
155 SACO AVE, OLD ORCHARD BEACH, ME 04064-1600
(207) 934-5411
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
5005
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431742900
MAINE CARE
ME
Enumeration date
05/07/2009
Last updated
05/07/2009
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