Provider Demographics
NPI:1306151626
Name:ELLIS, DAFNE ITATI (DMD MS)
Entity type:Individual
Prefix:DR
First Name:DAFNE
Middle Name:ITATI
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 UNION BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1834
Mailing Address - Country:US
Mailing Address - Phone:303-988-2780
Mailing Address - Fax:352-273-9671
Practice Address - Street 1:255 UNION BLVD STE 430
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1834
Practice Address - Country:US
Practice Address - Phone:303-988-2780
Practice Address - Fax:303-988-2783
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002018341223X0400X
FLDN18641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist