Individual
DR. ELI GEORGE ELLIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
911 MARKET ST, PORT GIBSON, MS 39150
(601) 437-5221
Mailing address
PO BOX 237, PORT GIBSON, MS 39150-0237
(601) 437-5670
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1099-63
MS
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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