Individual
DR. BURKE LEE ELLZEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
949 BROADWAY DR, HATTIESBURG, MS 39401-7534
(601) 271-7300
Mailing address
79 QUAIL HOLLOW DRIVE, HATTIESBURG, MS 39402-8972
(601) 606-4241
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4136-20
MS
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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