Individual
TY ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2650 E SHOW LOW LAKE RD STE 1, SHOW LOW, AZ 85901-7955
(928) 537-4300
(928) 532-6901
Mailing address
PO BOX 1231, TUCSON, AZ 85702-1231
(520) 670-3909
(520) 309-2560
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009461
AZ
Other
Enumeration date
06/06/2016
Last updated
04/21/2026
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