Individual
DR. KAITLYN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1008 MISSION PARK DR, VICKSBURG, MS 39180-3735
(601) 627-4100
(601) 629-4101
Mailing address
1008 MISSION PARK DR, VICKSBURG, MS 39180-3735
(601) 627-4100
(601) 629-4101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
387216
MS
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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