Individual
DR. PRESTON CHAD ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, DDS
Contact information
Practice address
3575 N 100 E STE 200, PROVO, UT 84604-6653
(801) 374-0070
Mailing address
3575 N 100 E STE 200, PROVO, UT 84604-6653
(801) 374-0070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
270828-9923
UT
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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