Individual
DR. TERESA EILEEN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1720 WEST AVE, SUITE 106, CROSSVILLE, TN 38555-4066
(931) 784-3007
Mailing address
1720 WEST AVE, SUITE 106, CROSSVILLE, TN 38555-4066
(931) 484-3007
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS8148
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5440078
—
TN
Enumeration date
10/24/2006
Last updated
02/28/2012
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