Individual
DR. TEDDY LYNN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6900 ALDEN DR, FT WARREN AFB, WY 82005-3906
(402) 651-1386
Mailing address
6900 ALDEN DRIVE, FT WARREN AFB, WY 82005
(402) 651-1386
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
06010
IA
Other
Enumeration date
08/30/2005
Last updated
07/08/2007
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