NPI 1891835310

Fred E Ellis, DPDDENTURISTOFPRO

Practitioner Denturist Olympia, WA

Practice location

Address: 1822 Black Lake Blvd SW Suite 101, Olympia, WA 98512
Phone: (360) 709-9909
Fax: (360) 709-9915

Registered specialties

Denturist Primary

Dental Providers Taxonomy 122400000X Licence DN00000358 (WA)

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Registry record

NPI: 1891835310
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Feb 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.