Individual
TRENT PARKER ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9040A JACKSON AVENUE, JOINT BASE LEWIS MCCHORD, WA 98431-7719
(253) 968-0174
Mailing address
9434 COPPERWAY, CONVERSE, TX 78109-2063
(801) 859-7315
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10101
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
61404526
WA
Other
Enumeration date
07/23/2018
Last updated
09/06/2023
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