Provider Demographics
NPI:1497825392
Name:ELLWEIN, ORIN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ORIN
Middle Name:W
Last Name:ELLWEIN
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:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:ALCESTER
Mailing Address - State:SD
Mailing Address - Zip Code:57001-0349
Mailing Address - Country:US
Mailing Address - Phone:605-934-2251
Mailing Address - Fax:
Practice Address - Street 1:111 IOWA STREET
Practice Address - Street 2:
Practice Address - City:ALCESTER
Practice Address - State:SD
Practice Address - Zip Code:57001-0349
Practice Address - Country:US
Practice Address - Phone:605-934-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM 4521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice