Individual
BRENT L ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2163HWY 54 EAST SUBURBAN PLAZA, SUITE C, LINTON, IN 47441
(812) 847-8601
(812) 847-8750
Mailing address
2163 HWY 54 EAST, LINTON, IN 47441
(812) 847-8601
(812) 847-8750
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008090
IN
Other
Enumeration date
03/12/2007
Last updated
07/08/2007
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