Individual
JILLIAN E. ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
136 PARTIN DR N, NICEVILLE, FL 32578-2054
(850) 678-7114
Mailing address
136 PARTIN DR N, NICEVILLE, FL 32578-2054
(850) 678-7114
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
19226
MA
122300000X
Dentist
Primary
DN16159
FL
Other
Enumeration date
08/25/2009
Last updated
08/25/2009
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