Provider Demographics
NPI:1649381013
Name:NELLIS, JOSHUA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:NELLIS
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 1:25211 GROGANS MILL RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2950
Mailing Address - Country:US
Mailing Address - Phone:281-367-0641
Mailing Address - Fax:281-292-4093
Practice Address - Street 1:25211 GROGANS MILL RD
Practice Address - Street 2:SUITE 290
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2950
Practice Address - Country:US
Practice Address - Phone:281-367-0641
Practice Address - Fax:281-292-4093
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice