Individual
DR. KEVIN JOHN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
205 34TH ST, SUITE 112, VIRGINIA BEACH, VA 23451-2836
(757) 428-5491
(757) 428-7663
Mailing address
1360 LITTLE NECK RD, VIRGINIA BEACH, VA 23452-4740
(757) 631-0553
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7176
VA
Other
Enumeration date
02/13/2006
Last updated
07/08/2007
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