Provider Demographics
NPI:1316036775
Name:ELLISON, RODNEY HOWDEN (DDS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:HOWDEN
Last Name:ELLISON
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 1:995 DOWDELL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1451
Mailing Address - Country:US
Mailing Address - Phone:707-963-4611
Mailing Address - Fax:707-963-1436
Practice Address - Street 1:995 DOWDELL LN
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1451
Practice Address - Country:US
Practice Address - Phone:707-963-4611
Practice Address - Fax:707-963-1436
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist