Individual
DR. TIMOTHY WAYNE ELLIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4955 S PEORIA AVE, TULSA, OK 74105-4629
(918) 895-6568
Mailing address
3929 W ANGELA DR, GLENDALE, AZ 85308-3012
(720) 427-4909
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7797
OK
122300000X
Dentist
D011115
AZ
Other
Enumeration date
08/25/2021
Last updated
09/30/2025
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