Ellis, Charles Lee

Ellis, Charles Lee is an sole proprietor health care provider with primary practice located at 2353 S Ridge Road , Green Bay WI 54304-5069. He recently has 3 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Ellis, Charles Lee can be contacted via phone (920) 499-0471.

Contact Information

Primary practice address
2353 S Ridge Road Green Bay WI 54304-5069
Phone: (920) 499-0471
Fax: (920) 499-8312
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 8919 North Carolina
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 0401411258 Virginia
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 019022235 Illinois
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 0101058265 Virginia
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 8919 North Carolina
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 8919 North Carolina

Profile Details

NPI number 1013098698
LBN Legal business name Ellis, Charles Lee
Credentials DDS, MD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 18th, 2006
Last updated Aug 20th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013098698 NPPES
North Carolina MEDICAID 5914023

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