Individual
DR. JACQUELINE DENISE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5535 NW 7TH AVE, MIAMI, FL 33127-1401
(305) 759-1145
(305) 759-1145
Mailing address
1607 PRESIDENTIAL WAY, MIAMI, FL 33179-6437
(305) 757-7763
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN0011584
FL
Other
Enumeration date
03/19/2007
Last updated
07/09/2007
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