DR. Mervin Lee Ellstrom, DDS
NPI #1083052138 in Moreno Valley, California
Provider Information
- NPI Number
- 1083052138
- Entity Type
- Individual
- Name
- DR. Mervin Lee Ellstrom, DDS
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist
- Credential
- DDS
- Enumeration Date
- Jun 11, 2013
- Last Updated
- Jun 11, 2013
Practice Location
- Address
- 12900 PERRIS BLVD
- Address 2
- SUITE 101
- City
- Moreno Valley
- State
- California
- ZIP Code
- 92553-4135
- Phone
- (951) 242-3431
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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