Individual
DR. FRED RAY ELLIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
233 S. PLEASANT AVE., #303, SOMERSET, PA 15501-2188
(814) 445-4636
(814) 445-1018
Mailing address
233 S. PLEASANT AVE., #303, SOMERSET, PA 15501-2188
(814) 445-4636
(814) 445-1018
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DSO22283L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0801431
DPA
PA
01
—
DSO22283L
DENTAL LICENSE
PA
Enumeration date
07/20/2006
Last updated
03/07/2023
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