Organization
ELLSWORTH DENTAL CARE
Active
Other names
Midtown Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE L ELLSWORTH DMD (OWNER)
(503) 476-5242
Entity
Organization
Contact information
Practice address
5701 W CHARLESTON BLVD STE 103, LAS VEGAS, NV 89146-1256
(503) 576-5242
Mailing address
5701 W CHARLESTON BLVD STE 103, LAS VEGAS, NV 89146-1256
(503) 576-5242
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/23/2023
Last updated
11/26/2023
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