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1881664514
LARISA ELLIS
OLD SAYBROOK, CT
NPI
1881664514
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: CT 009502)
Enumeration Date
2006-01-25
Last Update Date
2007-07-08
Business Address
-- LARISA ELLIS DDS
263 MAIN ST
OLD SAYBROOK, CT 06475-2326
Phone number: 860-388-4433
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Mailing Address
-- LARISA ELLIS DDS
635 MAIN ST ATTN: CREDENTIALING DEPARTMENT
MIDDLETOWN, CT 06457-2718
Phone number: 860-347-6971
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