Individual
DR. JEREMY W ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
965 S 100 W, #102, LOGAN, UT 84321-6062
(435) 752-9741
(435) 753-5169
Mailing address
965 S 100 W, #102, LOGAN, UT 84321-6062
(435) 752-9741
(435) 753-5169
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
99-373-9289922
UT
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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