Ellisville State School Dental

NPI #1013085414 in Ellisville, Mississippi

Provider Information

NPI Number: 1013085414
Entity Type: Organization
Organization Name: Ellisville State School Dental
Primary Specialty: Dentist
Enumeration Date: Dec 1, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 1101 HIGHWAY 11 S
City: Ellisville
State: Mississippi
ZIP Code: 39437-4443
Phone: (601) 477-9384

Authorized Official

Name: SUZIE LASSITER
Title: DIRECTOR OF FACILITY
Phone: (601) 477-9384

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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