Provider Demographics
NPI:1982813325
Name:ANGELA G. ELLIS, D.D.S., P.A.
Entity Type:Organization
Organization Name:ANGELA G. ELLIS, D.D.S., P.A.
Other - Org Name:ELLIS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-960-0155
Mailing Address - Street 1:120 CONNER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7092
Mailing Address - Country:US
Mailing Address - Phone:919-960-0155
Mailing Address - Fax:919-960-0551
Practice Address - Street 1:120 CONNER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7092
Practice Address - Country:US
Practice Address - Phone:919-960-0155
Practice Address - Fax:919-960-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty