Individual
DR. SAMUEL DWAYNE ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6333 E MOCKINGBIRD LN, SUITE 254, DALLAS, TX 75214-2692
(214) 827-9500
(214) 827-9502
Mailing address
6333 E MOCKINGBIRD LN, SUITE 254, DALLAS, TX 75214-2692
(214) 827-9500
(214) 827-9502
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
25488
TX
1223P0300X
Periodontics
Primary
25488
TX
Other
Enumeration date
11/18/2010
Last updated
02/18/2014
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