Individual
JUSTIN KADE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
343 FRANKLIN RD STE 103, BRENTWOOD, TN 37027
(615) 343-1313
Mailing address
343 FRANKLIN RD STE 103, BRENTWOOD, TN 37027-5250
(615) 343-1313
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10989
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2019
Last updated
06/28/2019
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