DR. Jeremy W Ellis, D.D.S.

NPI #1568558468 in Logan, Utah

Provider Information

NPI Number: 1568558468
Entity Type: Individual
Name: DR. Jeremy W Ellis, D.D.S.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: D.D.S.
Enumeration Date: Oct 5, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 965 S 100 W
Address 2: #102
City: Logan
State: Utah
ZIP Code: 84321-6062
Phone: (435) 752-9741

Specialties & Taxonomy Codes

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

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