Provider Demographics
NPI:1376547364
Name:ELLARD, JEFF D (DDS)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:D
Last Name:ELLARD
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 1:541 SHADOWS LN
Mailing Address - Street 2:STE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6531
Mailing Address - Country:US
Mailing Address - Phone:225-924-2010
Mailing Address - Fax:225-926-5872
Practice Address - Street 1:541 SHADOWS LN
Practice Address - Street 2:STE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6531
Practice Address - Country:US
Practice Address - Phone:225-924-2010
Practice Address - Fax:225-926-5872
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA35071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
810768OtherUNITED CONCORDIA PROV. #