Individual
DR. MARK E ELLICSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
33725 N SCOTTSDALE RD, STE101, SCOTTSDALE, AZ 85262-1560
(480) 515-5215
Mailing address
33725 N SCOTTSDALE RD, STE101, SCOTTSDALE, AZ 85262-1560
(480) 515-5215
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4513
AZ
Other
Enumeration date
06/04/2007
Last updated
07/08/2007
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