Individual
MRS. REBECCA ANN ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH, COM
Contact information
Practice address
1011 W MAPLE ST, SUITE 300, KALAMAZOO, MI 49008-1899
(269) 343-7811
Mailing address
1011 W MAPLE ST, SUITE 300, KALAMAZOO, MI 49008-1899
(269) 343-7811
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902005366
MI
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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