Individual
DR. BRANDON KEITH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
19638 LEITERSBURG PIKE STE 103, HAGERSTOWN, MD 21742-1516
(301) 739-1100
Mailing address
19638 LEITERSBURG PIKE, SUITE 103, HAGERSTOWN, MD 21742-1438
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12508
MD
Other
Enumeration date
08/22/2006
Last updated
10/30/2017
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