Organization
LAKE JACKSON FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS ELLISOR DDS (OWNER)
(979) 297-6438
Entity
Organization
Contact information
Practice address
103 N DIXIE DR, LAKE JACKSON, TX 77566-5940
(979) 297-6438
Mailing address
103 N DIXIE DR, LAKE JACKSON, TX 77566-5940
(979) 297-6438
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/01/2022
Last updated
11/01/2022
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