Individual
SCOTT ELLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1496 S SAINT FRANCIS DR, SANTA FE, NM 87505-4038
(505) 983-4491
Mailing address
1496 S SAINT FRANCIS DR, SANTA FE, NM 87505-4038
(505) 983-4491
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD3288
NM
1223G0001X
General Practice Dentistry
DD3288
NM
Other
Enumeration date
05/24/2010
Last updated
05/24/2010
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