Organization
ELLIS DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOLLY CHRISTINE ELLIS DDS (OWNER)
(314) 965-1334
Entity
Organization
Contact information
Practice address
10296 BIG BEND RD, SUITE 207, SAINT LOUIS, MO 63122-6498
(314) 965-1334
Mailing address
10296 BIG BEND RD, SUITE 207, SAINT LOUIS, MO 63122-6498
(314) 965-1334
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2006021179
MO
Other
Enumeration date
04/18/2017
Last updated
04/18/2017
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