Active NPI
Scott Bradley Ellis, DMD
- Dentist
- Dulles, VA
National Provider Identifier
1093040800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401411747
- Practice address
- 23520 Overland Dr Ste 134
Dulles, VA 20166-2197 - Phone
- (703) 661-3360
- Fax
- (703) 661-3363
- NPI assigned
- Oct 13, 2009
- Last updated
- Oct 13, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401411747 | VA | Primary |
Addresses
Primary practice location
23520 Overland Dr Ste 134
Dulles, VA 20166-2197
Mailing address
23520 Overland Dr Ste 134
Dulles, VA 20166-2197
Phone (703) 661-3360
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401411747 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255392000000",
"number": "1093040800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23520 OVERLAND DR STE 134",
"city": "DULLES",
"state": "VA",
"postal_code": "201662197",
"telephone_number": "703-661-3360",
"fax_number": "703-661-3363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23520 OVERLAND DR STE 134",
"city": "DULLES",
"state": "VA",
"postal_code": "201662197",
"telephone_number": "703-661-3360",
"fax_number": "703-661-3363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "SCOTT",
"middle_name": "BRADLEY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-13",
"last_updated": "2009-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401411747",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dulles, VA
- Dulles Family Eyecare LLC
- Dulles Town Center Optical, Inc (Sterling Optical)
- Dulles Town Center Optics (Sterling Optical)
- Jason David Edginton
- Elite Dental Care, P.C.
- Emergency Medicine Associates PA PC
- Emergency Medicine Associates, P.a.,P.C.
- Fairfax Family Practice Centers PC (South Riding Family Medicine)
- Iris Marion Carline Ferguson, RN, RNFA
- Karen Foster-Anderson, CNM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.