Individual
MR. FRED E ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPD DENTURIST OF PRO
Contact information
Practice address
1822 BLACK LAKE BLVD SW, SUITE 101, OLYMPIA, WA 98512
(360) 709-9909
(360) 709-9915
Mailing address
1822 BLACK LAKE BLVD SW, SUITE 101, OLYMPIA, WA 98512
(360) 709-9909
(360) 709-9915
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000358
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5046370
—
WA
Enumeration date
02/07/2007
Last updated
07/08/2007
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