Provider Demographics
NPI:1407042492
Name:ELY, JAMES HOWARD
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HOWARD
Last Name:ELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N UNION RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5339
Mailing Address - Country:US
Mailing Address - Phone:716-633-1187
Mailing Address - Fax:716-633-4273
Practice Address - Street 1:40 N UNION RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5339
Practice Address - Country:US
Practice Address - Phone:716-633-1187
Practice Address - Fax:716-633-4273
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry