DR. Shane L Ellsworth, DMD
NPI #1639379522 in Mcminnville, Oregon
Provider Information
- NPI Number
- 1639379522
- Entity Type
- Individual
- Name
- DR. Shane L Ellsworth, DMD
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist - General Practice
- Credential
- DMD
- Enumeration Date
- Jul 19, 2007
- Last Updated
- Jan 6, 2011
Practice Location
- Address
- 704 NE EVANS ST
- City
- Mcminnville
- State
- Oregon
- ZIP Code
- 97128-3926
- Phone
- (503) 472-1404
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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