Provider Demographics
NPI:1154545747
Name:ELLIS, BITA ASHLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:BITA
Middle Name:ASHLEY
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:SUNSHINE DENTISTS
Mailing Address - Street 2:6035 BURBLE CENTRE PKWY SUITE #260
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-978-1446
Mailing Address - Fax:703-715-9229
Practice Address - Street 1:SUNSHINE DENTISTS
Practice Address - Street 2:6035 BURBLE CENTRE PKWY SUITE #260
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-978-1446
Practice Address - Fax:703-715-9229
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-4111061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401-411106OtherVA. DENTAL LICENSE