| Ellis Orthodontics, Llc | |
|
275 Us Highway 30 Suite 260 Dyer IN 46311-1776 | |
| (219) 322-7645 | |
| Not Available |
| Full Name | Ellis Orthodontics, Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 275 Us Highway 30, Dyer, Indiana |
| Authorized Official Name and Position | Lawrence Charles Ellis (ORTHODONTIST) |
| Authorized Official Contact | 2193227645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis Orthodontics, Llc 275 Us Highway 30 Suite 260 Dyer IN 46311-1776 Ph: (219) 322-7645 | Ellis Orthodontics, Llc 275 Us Highway 30 Suite 260 Dyer IN 46311-1776 Ph: (219) 322-7645 |
| NPI Number | 1700070331 |
|---|---|
| Provider Enumeration Date | 08/27/2007 |
| Last Update Date | 08/27/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700070331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 12009958A (Indiana) | Primary |
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