Individual
DR. SUSAN ANNE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7900 LEES SUMMIT RD, KANSAS CITY, MO 64139-1236
(816) 404-6885
Mailing address
3615 W ROANOKE DR, KANSAS CITY, MO 64111-3835
(816) 753-7820
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
MO13609
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MO13609
STATE LICENSE
MO
Enumeration date
08/29/2006
Last updated
03/07/2023
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