Organization
SNELLVILLE ORAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE ELLIS DMD (OWNER)
(770) 972-7911
Entity
Organization
Contact information
Practice address
2221 KNOLLWOOD DRIVE, SNELLVILLE, GA 30078
(770) 972-7911
(770) 978-3767
Mailing address
2221 KNOLLWOOD DRIVE, SNELLVILLE, GA 30078
(770) 972-7911
(770) 978-3767
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
07968
GA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN012320
GA
Other
Enumeration date
12/13/2007
Last updated
02/21/2013
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