Individual
DR. DAVID LARRY ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3314 OAKLAWN BLVD, HOPEWELL, VA 23860-4704
(804) 458-6733
(804) 541-0416
Mailing address
3314 OAKLAWN BLVD, HOPEWELL, VA 23860-4704
(804) 458-6733
(804) 541-0416
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401005245
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122419
UNITED CONCORDIA NUMBER
VA
01
—
186711
ANTHEM NUMBER
VA
01
—
5245
DENTAL LICENSE NUMBER
VA
05
—
9179650
—
VA
Enumeration date
03/06/2006
Last updated
07/09/2007
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