Individual
DANIEL G ELLENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
3285
WI
1223E0200X
Endodontics
S65
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33479800
—
WI
Enumeration date
06/16/2005
Last updated
07/25/2013
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