DR. Preston Chad Ellis, MS, DDS

NPI #1518215458 in Provo, Utah

Provider Information

NPI Number: 1518215458
Entity Type: Individual
Name: DR. Preston Chad Ellis, MS, DDS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: MS, DDS
Enumeration Date: Aug 27, 2012
Last Updated: Aug 27, 2012

Practice Location

Address: 3575 N 100 E STE 200
City: Provo
State: Utah
ZIP Code: 84604-6653
Phone: (801) 374-0070

Specialties & Taxonomy Codes

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

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