Jesse Ellsworth, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS10287 Issued in TN

Practice address

126 E Division Rd
Oak Ridge, TN 37830-6906

Phone

(865) 481-0008

Fax

(865) 481-0695

NPI assigned

Jul 6, 2016

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Professional Dental Alliance of Tennessee, PLLC

  • General Practice Dentistry
  • Chattanooga, TN
  • NPI 1730725953
  NPD (past)

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1043662778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 GARRISON RIDGE BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379225155",
            "telephone_number": "801-598-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 E DIVISION RD",
            "city": "OAK RIDGE",
            "state": "TN",
            "postal_code": "378306906",
            "telephone_number": "865-481-0008",
            "fax_number": "865-481-0695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "JESSE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-06",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "DS10287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elcm Oak Ridge Management LLC
• Elite Pain Consultants, PLLC
• Jessica Ellam, NP
• Alicia Ellis, NP
• Seta Lamallari Ellis, DO
• Emory Valley Center
• Endocrine Associates, P.C.
• Endoscopy Center of Oak Ridge, LLC
• James Arthur Engblom, DPM
• Okon Enyenihi, MD

• All providers in Oak Ridge, TN
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.