Individual
DR. MICHAEL BARRY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.,P.A.
Contact information
Practice address
1008 MISSION PARK DR, VICKSBURG, MS 39180-3735
(601) 629-4100
(601) 629-4101
Mailing address
1008 MISSION PARK DR, VICKSBURG, MS 39180-3735
(601) 629-4100
(601) 629-4101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
204783
MS
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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