Individual
DR. DAVID MICHAEL ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
17583 OLD JEFFERSON HWY, PRAIRIEVILLE, LA 70769-3930
(225) 673-2200
Mailing address
17583 OLD JEFFERSON HWY, PRAIRIEVILLE, LA 70769-3930
(225) 673-2200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5098
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
721425524
GENERAL DENTISTRY
LA
Enumeration date
07/31/2008
Last updated
02/10/2015
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