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1083052138
MERVIN LEE ELLSTROM
MORENO VALLEY, CA
NPI
1083052138
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: CA 024928)
Enumeration Date
2013-06-11
Last Update Date
2013-06-11
Business Address
Dr. MERVIN LEE ELLSTROM dds
12900 PERRIS BLVD SUITE 101
MORENO VALLEY, CA 92553-4135
Phone number: 951-242-3431
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Mailing Address
Dr. MERVIN LEE ELLSTROM dds
12900 PERRIS BLVD SUITE 101
MORENO VALLEY, CA 92553-4135
Phone number: 951-242-3431
Copy
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