Ellis, Willard Jackson
Ellis, Willard Jackson is an individual health care provider with primary practice located at 3136 Sunset Avenue , Rocky Mount NC 27804-3650. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Ellis, Willard Jackson can be contacted via phone (252) 443-9121.Contact Information
Primary practice address
3136 Sunset Avenue
Rocky Mount NC 27804-3650
Phone: (252) 443-9121
Fax: (252) 443-9836
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 4633 | North Carolina |
Profile Details
| NPI number | 1306965140 |
|---|---|
| LBN Legal business name | Ellis, Willard Jackson |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 29th, 2007 |
| Last updated | Mar 7th, 2023 - about 2 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 | 1306965140 | NPPES |
| North Carolina | MEDICAID | 7992473 |
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