Doctor Name: | STEVEN L. ELLIS |
NPI Number: | 1255565065 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LD |
License Number: | 5005 |
Business Practice Address: | 155 Saco Ave Old Orchard Beach, ME - 040641600 |
Business Phone Number: | 2079345411 |
Business Fax Number: | |
Mailing Address: | 155 Saco Ave, OLD ORCHARD BEACH |
State: | ME |
Postal Code: | 040641600 |
Phone Number: | 2079345411 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2009 |
NPI Last Update Date: | 05/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | 5005 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |