Randall A. Ellis, Dds, Pllc

NPI #1114619657 in Texarkana, Texas

Provider Information

NPI Number: 1114619657
Entity Type: Organization
Organization Name: Randall A. Ellis, Dds, Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: May 23, 2023
Last Updated: May 23, 2023

Practice Location

Address: 4617 SUMMERHILL RD STE 3
City: Texarkana
State: Texas
ZIP Code: 75503-2783
Phone: (903) 838-5506

Authorized Official

Name: RANDALL ALLEN ELLIS, DDS
Title: OWNER/DENTIST
Phone: (903) 838-5506

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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