Provider Demographics
NPI:1255863791
Name:DRS. CALABRIA-ELLIS, P.C.
Entity Type:Organization
Organization Name:DRS. CALABRIA-ELLIS, P.C.
Other - Org Name:GATEWAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-858-6333
Mailing Address - Street 1:4013 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5917
Mailing Address - Country:US
Mailing Address - Phone:817-858-6333
Mailing Address - Fax:817-868-0068
Practice Address - Street 1:4013 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5917
Practice Address - Country:US
Practice Address - Phone:817-858-6333
Practice Address - Fax:817-868-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty