Ellison, Larry Johnson
Ellison, Larry Johnson is an individual health care provider with primary practice located at 615 N 90Th St , Omaha NE 68114-2821. He recently has only one registered license in Dental Providers / Endodontics, which is considered as his primary health care specialty. Ellison, Larry Johnson can be contacted via phone (402) 393-5050.Contact Information
Primary practice address
615 N 90Th St
Omaha NE 68114-2821
Phone: (402) 393-5050
Fax: (402) 393-3401
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Endodontics | 1223E0200X | 5949 | Nebraska |
Profile Details
| NPI number | 1235236217 |
|---|---|
| LBN Legal business name | Ellison, Larry Johnson |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 20th, 2006 |
| Last updated | Aug 28th, 2008 - about 16 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 | 1235236217 | NPPES |
| Nebraska | Other | 04989 | BLUE CROSS AND BLUE SHILED |
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