Holly Ellis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2006021179 Issued in MO

Practice address

10296 Big Bend Rd Ste 207
Saint Louis, MO 63122-6582

Phone

(314) 965-1334

Fax

(314) 965-0679

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ellis Dental LLC

  • Dental Clinic/Center
  • Saint Louis, MO
  • NPI 1558895490
  NPD Authorized official
• Ellis Sleep Center LLC

  • Durable Medical Equipment & Medical Supplies
  • Saint Louis, MO
  • NPI 1902511454
  NPD Authorized official
• Nevin K Waters DDS, PA

  • General Practice Dentistry
  • Overland Park, KS
  • NPI 1922029057
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1013027937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10296 BIG BEND RD STE 207",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631226582",
            "telephone_number": "314-965-1334",
            "fax_number": "314-965-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10296 BIG BEND RD STE 207",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631226582",
            "telephone_number": "314-965-1334",
            "fax_number": "314-965-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "HOLLY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2006021179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alysa Gail Ellis, MD
• Andrew James Ellis, M.D.
• Carol A Ellis, RN
• Christine M Ellis, FNP
• Denise Michele Ellis, P.T.
• Jabon L Ellis, D.O.
• Kathryn Gail Ellis, MSW
• Katrece Levoy Ellis, CRNA
• Lisa Ellis
• Mattalue Ellis, M.A.

• General Practice Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.