Individual
DR. MATTHEW T ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
WOMACK ARMY MEDICAL CENTER 2817 REILLY ROAD, FORT LIBERTY, NC 28310-0001
(910) 907-6974
Mailing address
2828 W AVENUE O4, PALMDALE, CA 93551-3402
(661) 917-4077
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11258
OR
Other
Enumeration date
07/21/2020
Last updated
06/13/2023
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