Individual
DR. KENNETH CLAY ELLIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, LLC
Contact information
Practice address
311 S 5TH ST STE A, GADSDEN, AL 35901-4253
(256) 543-1285
(256) 543-1719
Mailing address
311 S 5TH ST STE A, GADSDEN, AL 35901-4253
(256) 543-1285
(256) 543-1719
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3842
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008303580
—
AL
Enumeration date
09/22/2006
Last updated
06/14/2022
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