Provider Demographics
NPI:1275740854
Name:DENNIS W ELLIS, DDS, PA
Entity Type:Organization
Organization Name:DENNIS W ELLIS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-968-9806
Mailing Address - Street 1:88 VILCOM CTR STE 190
Mailing Address - Street 2:
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:919-968-7799
Practice Address - Street 1:88 VILCOM CTR STE 190
Practice Address - Street 2:
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:919-968-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty