| NPI | 1710092937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MICHAEL ELLIS Dentist/Owner 225-673-2200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5098) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-02-10 |