Ellis, Gary Lynn
Ellis, Gary Lynn is an individual health care provider with primary practice located at 500 Chipeta Way , Salt Lake City UT 84108-1221. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Pathology, which is considered as his primary health care specialty. Ellis, Gary Lynn can be contacted via phone (801) 583-2787.Contact Information
Primary practice address
500 Chipeta Way
Salt Lake City UT 84108-1221
Phone: (801) 583-2787
Fax: (801) 584-5255
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Pathology | 1223P0106X | 5129775-9921 | Utah |
Profile Details
| NPI number | 1700840717 |
|---|---|
| LBN Legal business name | Ellis, Gary Lynn |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700840717 | NPPES |
| Utah | Other | 5129775-9921 | DENTAL LICENSE |
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