Ellie Severance, DDS
Individual provider Active NPI General Practice Dentistry · Odessa, MO
NPI 1063254381 · NPPES record last updated Jun 7, 2024
Key facts
- NPI
- 1063254381
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2024019283 (MO)
- Practice address
- 404 N 4TH St
Odessa, MO 64076-1152 - Phone
- (573) 691-7700
- NPI assigned
- Jun 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024019283 | MO | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2024019283 | MO | Yes |
Addresses
Primary practice location
404 N 4TH St
Odessa, MO 64076-1152
Mailing address
728 Hobbs Rd
Jefferson City, MO 65109-6817
Phone (573) 691-7700
Other providers in Odessa, MO
- School Dist R7
- Stephan Louis Schowengerdt
- Suzan R Schuetz
- Serc of Odessa Inc
- Serc Rehabilitation Partners, LLC
- Kelley S. Sims
- Julie Anna Smith
- Mallory Lynn Steffen
- Elizabeth Stephenson
- Lauren M Stephenson
All providers in Odessa, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.