Individual
DR. MONA TW ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1289 BOULEVARD ST, ORANGEBURG, SC 29115-3401
(803) 533-0626
(803) 533-0627
Mailing address
1289 BOULEVARD ST, ORANGEBURG, SC 29115-3401
(803) 533-0626
(803) 533-0627
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2103
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZ2103
—
SC
Enumeration date
11/07/2006
Last updated
07/08/2007
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