DR. Jeffrey Mark Ellis, D.D.S., M.S.,C.N.S

NPI #1417087719 in Medford, New York

Provider Information

NPI Number: 1417087719
Entity Type: Individual
Name: DR. Jeffrey Mark Ellis, D.D.S., M.S.,C.N.S
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: D.D.S., M.S.,C.N.S
Enumeration Date: Mar 6, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 3237 ROUTE 112
Address 2: BLDG 6
City: Medford
State: New York
ZIP Code: 11763-1424
Phone: (631) 698-6934

Specialties & Taxonomy Codes

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

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