Individual
DR. MICHAEL LYNN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
24 N CHURCH ST, SUITE 206, WAILUKU, HI 96793-1680
(808) 242-0077
(808) 243-8004
Mailing address
24 N CHURCH ST, SUITE 206, WAILUKU, HI 96793-1680
(808) 242-0077
(808) 243-8004
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
14623
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DT2031
HI
Other
Enumeration date
01/15/2007
Last updated
05/12/2015
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