Provider Demographics
NPI:1851530315
Name:ELLENDER, ALBERT PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:PHILIP
Last Name:ELLENDER
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 1:102 RAMEY RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4056
Mailing Address - Country:US
Mailing Address - Phone:985-851-1234
Mailing Address - Fax:
Practice Address - Street 1:102 RAMEY RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4056
Practice Address - Country:US
Practice Address - Phone:985-851-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA28131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics