Provider Demographics
NPI:1851645865
Name:ELLIS, SONJA (DDS)
Entity type:Individual
Prefix:DR
First Name:SONJA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15511 STATE HIGHWAY 71 WEST
Mailing Address - Street 2:SUITE # 120
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5617
Mailing Address - Country:US
Mailing Address - Phone:512-540-4644
Mailing Address - Fax:512-540-4655
Practice Address - Street 1:15511 ST HWY 71 W STE 120
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-2825
Practice Address - Country:US
Practice Address - Phone:512-540-4644
Practice Address - Fax:512-540-4644
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist