Individual
DR. CHASE DANIEL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DS-041898
PA
1223P0221X
Pediatric Dentistry
Primary
DS041898
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1035609330001
—
PA
Enumeration date
06/06/2017
Last updated
07/21/2022
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