Organization
JERRY R ELLIS DDS PC
Active
Other names
Jerry R Ellis DDS PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY R ELLIS DDS (OWNER/DENTIST)
(972) 775-2345
Entity
Organization
Contact information
Practice address
404 W MAIN ST, MIDLOTHIAN, TX 76065-2946
(972) 775-2345
Mailing address
404 W MAIN ST, MIDLOTHIAN, TX 76065-2946
(972) 775-2345
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
03/06/2023
Last updated
04/20/2023
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