Organization
BASIN PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ZACHARY ELLIS DDS (PEDIATRIC DENTIST)
(210) 275-2214
Entity
Organization
Contact information
Practice address
711 HOSPITAL DR, ANDREWS, TX 79714-3616
(432) 523-3194
Mailing address
711 HOSPITAL DR, ANDREWS, TX 79714-3616
(432) 523-3194
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
23989
TX
Other
Enumeration date
04/02/2012
Last updated
04/18/2012
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