Individual
JEFF D. ELLARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
541 SHADOWS LN, STE B, BATON ROUGE, LA 70806-6531
(225) 924-2010
(225) 926-5872
Mailing address
541 SHADOWS LN, STE B, BATON ROUGE, LA 70806-6531
(225) 924-2010
(225) 926-5872
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3507
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
810768
UNITED CONCORDIA PROV. #
—
Enumeration date
06/08/2005
Last updated
07/08/2007
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