Provider Demographics
NPI:1720052970
Name:EZZIE, ELIE E (DDS)
Entity type:Individual
Prefix:
First Name:ELIE
Middle Name:E
Last Name:EZZIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 BISSONNET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3102
Mailing Address - Country:US
Mailing Address - Phone:713-779-9000
Mailing Address - Fax:713-779-9001
Practice Address - Street 1:4548 BISSONNET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3102
Practice Address - Country:US
Practice Address - Phone:713-779-9000
Practice Address - Fax:713-779-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD66701223E0200X
TX251121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics