Provider Demographics
NPI:1699932921
Name:JOHN D. ELLINGTON DDS PA
Entity type:Organization
Organization Name:JOHN D. ELLINGTON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-431-9571
Mailing Address - Street 1:3203 ARCHDALE RD
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2709
Mailing Address - Country:US
Mailing Address - Phone:336-431-9571
Mailing Address - Fax:336-431-5691
Practice Address - Street 1:3203 ARCHDALE RD
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2709
Practice Address - Country:US
Practice Address - Phone:336-431-9571
Practice Address - Fax:336-431-5691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty