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Individual

MATTHEW RYAN ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
8454 HIGHWAY 7, ST LOUIS PARK, MN 55426-3900
(952) 933-3667
Mailing address
5389 EMPIRE LN N, PLYMOUTH, MN 55446-3916
(949) 769-1820

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
101852
CA
122300000X
Dentist
Primary
D14822
MN

Other

Enumeration date
08/10/2017
Last updated
02/22/2024
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