Individual
MS. EDA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
30 CENTRAL PARK S, SUITE 7A, NEW YORK, NY 10019-1628
(212) 753-1119
(212) 753-1121
Mailing address
30 CENTRAL PARK S, SUITE 7A, NEW YORK, NY 10019-1628
(212) 753-1119
(212) 753-1121
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
044489
NY
Other
Enumeration date
07/17/2007
Last updated
07/17/2007
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