David Chad Ellis, D.D.S.

Individual provider Active NPI General Practice Dentistry · Greenbrier, TN

NPI 1841397007 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1841397007
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
DS7699 (TN)
Practice address
2524 Highway 41 S
Greenbrier, TN 37073-4544
Phone
(615) 643-4006
Fax
(615) 643-8610
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
DS7699TNMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS7699 TN Yes

Addresses

Primary practice location

2524 Highway 41 S
Greenbrier, TN 37073-4544

Mailing address

2524 Highway 41 S
Greenbrier, TN 37073-4544
Phone (615) 643-4006

Other providers in Greenbrier, TN

All providers in Greenbrier, TN · General Practice Dentistry in Tennessee

Sources for this page

Verify at the official NPI Registry.