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Individual

DR. GREGORY H. ELLIS

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
33 TEMPLE ST, RUTLAND, VT 05701-3543
(802) 775-0408
Mailing address
40 WASHINGTON ST, RUTLAND, VT 05701-5031
(802) 773-8665

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0160000609
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0001858
VT
01
0609
STATE LICENSE
VT
Enumeration date
06/15/2006
Last updated
07/08/2007
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