Individual
RANDY KYLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2015 BROADWAY ST, PEARLAND, TX 77581-5698
(281) 485-6003
Mailing address
2015 BROADWAY ST, PEARLAND, TX 77581-5698
(281) 485-6003
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
15404
TX
Other
Enumeration date
02/27/2008
Last updated
02/27/2008
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