Provider Demographics
NPI:1619092152
Name:DRS. ELLIS & MEFFORD DENTAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:DRS. ELLIS & MEFFORD DENTAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-434-1370
Mailing Address - Street 1:2806 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5166
Mailing Address - Country:US
Mailing Address - Phone:423-434-1370
Mailing Address - Fax:423-434-9965
Practice Address - Street 1:2806 W MARKET ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5166
Practice Address - Country:US
Practice Address - Phone:423-434-1370
Practice Address - Fax:423-434-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0041871223G0001X
TNDS0079661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty