Preston Chad Ellis, MS, DDS Valid NPI
Individual provider · General Practice Dentistry · Provo, UT
- NPI
- 1518215458
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 270828-9923 (UT)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2012-08-27
- Last updated
- 2012-08-27
Practice location
3575 N 100 E Ste 200
Provo, UT 84604-6653
(801) 374-0070