Ellsworth, Samuel Dwayne

Ellsworth, Samuel Dwayne is an individual health care provider with primary practice located at 6333 E Mockingbird Ln Suite 254, Dallas TX 75214-2692. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Periodontics. Dental Providers / Periodontics is his primary health care specialty. Ellsworth, Samuel Dwayne can be contacted via phone (214) 827-9500.

Contact Information

Primary practice address
6333 E Mockingbird Ln Suite 254 Dallas TX 75214-2692
Phone: (214) 827-9500
Fax: (214) 827-9502
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 25488 Texas
Dental Providers / Periodontics 1223P0300X 25488 Texas

Profile Details

NPI number 1891097168
LBN Legal business name Ellsworth, Samuel Dwayne
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2010
Last updated Feb 18th, 2014 - about 11 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.

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