Provider Demographics
NPI:1841397007
Name:ELLIS, DAVID CHAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHAD
Last Name:ELLIS
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 1:2524 HIGHWAY 41 S
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-4544
Mailing Address - Country:US
Mailing Address - Phone:615-643-4006
Mailing Address - Fax:615-643-8610
Practice Address - Street 1:2524 HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:TN
Practice Address - Zip Code:37073-4544
Practice Address - Country:US
Practice Address - Phone:615-643-4006
Practice Address - Fax:615-643-8610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS76991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice