Provider Demographics
NPI:1659590214
Name:ERIC ELLIS DDS PC
Entity Type:Organization
Organization Name:ERIC ELLIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-991-1361
Mailing Address - Street 1:4600 FAIRMONT PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3335
Mailing Address - Country:US
Mailing Address - Phone:281-991-1361
Mailing Address - Fax:281-991-9190
Practice Address - Street 1:4600 FAIRMONT PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3335
Practice Address - Country:US
Practice Address - Phone:281-991-1361
Practice Address - Fax:281-991-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty