Individual
JACOB THOMAS ELLENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
102 RAMEY RD, HOUMA, LA 70360-4056
(985) 851-1234
Mailing address
102 RAMEY RD, HOUMA, LA 70360-4056
(985) 851-1234
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7029
LA
Other
Enumeration date
12/02/2021
Last updated
12/02/2021
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