Individual
DR. EMERSON RUSSELL EHLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MSD
Contact information
Practice address
4710 AMBER VALLEY PKWY S, SUITE B, FARGO, ND 58104-8694
(701) 293-5300
Mailing address
4710 AMBER VALLEY PKWY S, SUITE B, FARGO, ND 58104-8694
(701) 293-5300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
390200000X
MN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2171
ND
Other
Enumeration date
11/18/2009
Last updated
10/03/2014
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