| Terry R. Ellis, Dmd, Pc | |
|
1244 Augusta West Pkwy Augusta GA 30909-1854 | |
| (706) 855-7220 | |
| (706) 855-7260 |
| Full Name | Terry R. Ellis, Dmd, Pc |
|---|---|
| Speciality | Dentist |
| Location | 1244 Augusta West Pkwy, Augusta, Georgia |
| Authorized Official Name and Position | Terry R Ellis (PRESIDENT) |
| Authorized Official Contact | 7068557220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Terry R. Ellis, Dmd, Pc 1244 Augusta West Pkwy Augusta GA 30909-1854 Ph: (706) 855-7220 | Terry R. Ellis, Dmd, Pc 1244 Augusta West Pkwy Augusta GA 30909-1854 Ph: (706) 855-7220 |
| NPI Number | 1558795930 |
|---|---|
| Provider Enumeration Date | 08/21/2013 |
| Last Update Date | 08/21/2013 |
| Medicare PECOS PAC ID | 1557504214 |
|---|---|
| Medicare Enrollment ID | O20130828000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558795930 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Terry R Ellis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255307831 PECOS PAC ID: 5193968865 Enrollment ID: I20130828000166 |
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