Individual
DR. LAWRENCE C. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
275 US HIGHWAY 30, SUITE 260, DYER, IN 46311-1776
(219) 322-7645
Mailing address
275 US HIGHWAY 30, SUITE 260, DYER, IN 46311-1776
(219) 322-7645
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12009958A
IN
Other
Enumeration date
11/27/2007
Last updated
11/27/2007
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