Individual
TIMOTHY RAY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
11836 ELM ST, SUITE 1, OMAHA, NE 68144-4438
(402) 334-8208
(402) 334-1106
Mailing address
11836 ELM ST, SUITE 1, OMAHA, NE 68144-4438
(402) 334-8208
(402) 334-1106
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4536
NE
Other
Enumeration date
08/08/2012
Last updated
08/08/2012
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