Individual
DR. JORDAN MICHAEL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1900 EAST MAIN ST, DANVILLE, IL 61832-6183
(217) 554-3000
Mailing address
1118 DOUGLAS ST, ALTON, IL 62002-2219
(217) 799-9533
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019031635
IL
Other
Enumeration date
06/05/2018
Last updated
07/13/2020
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