Jerry R Ellis DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13742 Issued in TX

Practice address

404 W Main St
Midlothian, TX 76065-2946

Phone

(972) 775-2345

Fax

(972) 775-4729

NPI assigned

May 31, 2005

Sex

Male

Sole proprietor

No

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 TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1073516365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W MAIN ST",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760652946",
            "telephone_number": "972-775-2345",
            "fax_number": "972-775-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W MAIN ST",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760652946",
            "telephone_number": "972-775-2345",
            "fax_number": "972-775-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS DDS PC",
        "first_name": "JERRY",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dynasty Services Inc
• Charles Branden Ean, DDS
• El-Roi Healthcare LLC
• Jenna Elliott, MS,BCBA
• Ellis County Counseling PLLC
• Elroi Cares- Health&Community Services, LLC
• Iyore J Emokpae, RN
• Oyemwen Lucia Emokpae
• Enabling Grace LLC
• Kelsey Christine English, MD

• General Practice Dentistry in Midlothian, TX
• Providers in Midlothian, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.