Individual
DR. CHARLES CHASE ELLINWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5725 MAPLECREST RD STE 1, FORT WAYNE, IN 46835-4937
(260) 370-6559
Mailing address
5725 MAPLECREST RD STE 1, FORT WAYNE, IN 46835-4937
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013137A
IN
Other
Enumeration date
05/21/2019
Last updated
12/19/2019
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