| NPI | 1326610221 |
|---|---|
| Doing Business As | ELLIS FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | CHAD HENDRICKS Credentialing Manager 612-859-0444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |