NPI 1023079654 · live from the CMS NPI Registry
Robert H. Ellis, DMD
Dentist, Pediatric Dentistry in Columbia, SC. National Provider Identifier 1023079654, active.
NPI record
| NPI | 1023079654 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Pediatric Dentistry 1223P0221X |
| Practice location | 8905 Two Notch Rd, Columbia, SC 29223 |
| Practice phone | 803-788-9593 |
| Enumerated | March 31, 2006 |
| Last updated | April 10, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | 10406 (SC) |
| Dentist, Pediatric Dentistry primary | 1223P0221X | 3691 (SC) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.