Individual
ELLYSE LOOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1729 W HARVARD AVE STE 1, ROSEBURG, OR 97471-2795
(541) 673-0131
Mailing address
1729 W HARVARD AVE STE 1, ROSEBURG, OR 97471-2795
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11539
OR
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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