Provider Demographics
NPI:1437304490
Name:ELLIS, JENNIFER JANEE' (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANEE'
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5411
Mailing Address - Country:US
Mailing Address - Phone:406-586-5094
Mailing Address - Fax:406-587-3872
Practice Address - Street 1:1820 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5411
Practice Address - Country:US
Practice Address - Phone:406-586-5094
Practice Address - Fax:406-587-3872
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist