Provider Demographics
NPI:1518214881
Name:ELLIS, PAMELA KIMBER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KIMBER
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:KIMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:242 SHARRON LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3735
Mailing Address - Country:US
Mailing Address - Phone:719-686-4320
Mailing Address - Fax:
Practice Address - Street 1:1690 RIMROCK RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0700
Practice Address - Country:US
Practice Address - Phone:406-948-8900
Practice Address - Fax:406-948-8902
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4934289-9921122300000X, 1223G0001X
MT116481223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist