Individual
DR. ROBERT H. ELLIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8905 TWO NOTCH RD, COLUMBIA, SC 29223-6367
(803) 788-9593
(803) 788-3123
Mailing address
8905 TWO NOTCH RD, COLUMBIA, SC 29223-6367
(803) 788-9593
(803) 788-3123
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1266
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z12665
—
SC
05
—
ZA9724
—
SC
Enumeration date
03/31/2006
Last updated
09/11/2014
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