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5235 W. Baseline Rd, Ste 187 Laveen AZ 85339 | |
| (602) 883-8649 | |
| (602) 744-8778 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 5235 W. Baseline Rd, Ste 187, Laveen, Arizona |
| Authorized Official Name and Position | Eric E Ellis (OWNER DOCTOR) |
| Authorized Official Contact | 6028838649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
17000 Red Hill Ave Irvine CA 92614-5626 Ph: (714) 845-8656 | 5235 W. Baseline Rd, Ste 187 Laveen AZ 85339 Ph: (602) 883-8649 |
| NPI Number | 1962850073 |
|---|---|
| Provider Enumeration Date | 05/31/2016 |
| Last Update Date | 06/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962850073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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