Provider Demographics
NPI:1275690299
Name:ELLIS, DENNIS WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WILLIAM
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 VILCOM CTR
Mailing Address - Street 2:SUITE # 190
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1660
Mailing Address - Country:US
Mailing Address - Phone:919-968-9806
Mailing Address - Fax:
Practice Address - Street 1:88 VILCOM CTR
Practice Address - Street 2:SUITE # 190
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1660
Practice Address - Country:US
Practice Address - Phone:919-968-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist