Provider Demographics
NPI:1609824275
Name:ELLING, GAYLORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAYLORD
Middle Name:
Last Name:ELLING
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 1:9355 BANDERA ROAD
Mailing Address - Street 2:STE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250
Mailing Address - Country:US
Mailing Address - Phone:210-509-0300
Mailing Address - Fax:210-509-3950
Practice Address - Street 1:9355 BANDERA ROAD
Practice Address - Street 2:STE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250
Practice Address - Country:US
Practice Address - Phone:210-509-0300
Practice Address - Fax:210-509-3950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice