Provider Demographics
NPI:1740430586
Name:ELLIS, JESS TAYLOR (DDS, MS)
Entity Type:Individual
Prefix:MR
First Name:JESS
Middle Name:TAYLOR
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1120 HUFFMAN ROAD SUITE #24 BOX #214
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-349-3636
Mailing Address - Fax:907-272-3635
Practice Address - Street 1:8301 BRIARWOOD STREET #201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518
Practice Address - Country:US
Practice Address - Phone:907-272-3636
Practice Address - Fax:907-272-3635
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2023-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics