Suzanne M Ebert, DMD, FAGD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14846 Issued in FL

Practice address

151 Sawgrass Corners Dr
Suite 102
Ponte Vedra Beach, FL 32082-3553

Phone

(904) 543-0568

NPI assigned

Jan 31, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104963826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SAWGRASS CORNERS DR",
            "address_2": "SUITE 102",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823553",
            "telephone_number": "904-543-0568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 SAWGRASS CORNERS DR",
            "address_2": "SUITE 102",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823553",
            "telephone_number": "904-543-0568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERT",
        "first_name": "SUZANNE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DMD, FAGD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "14846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michelle Lynae Ellis, BA, RBT

• General Practice Dentistry in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.