NPIMap

Organization Active NPI

Randall a. Ellis, DDS, PLLC

  • General Practice Dentistry
  • Texarkana, TX
National Provider Identifier
1114619657
Registry record updated May 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
RANDALL A. ELLIS, DDS, PLLC
Practice address
4617 Summerhill Rd Ste 3
Texarkana, TX 75503-2783
Phone
(903) 838-5506
NPI assigned
May 23, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Randall Allen Ellis, DDSNPI 1740328046
Title
Owner/Dentist
Phone
(903) 838-5506

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

4617 Summerhill Rd Ste 3
Texarkana, TX 75503-2783

Mailing address

4617 Summerhill Rd Ste 3
Texarkana, TX 75503-2783
Phone (039) 838-5506

National Provider Directory

National Provider Directory
Tax ID family
Randall a Ellis DDS PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4617 Summerhill Rd
Ste 3
Texarkana, TX 75503
Phone (903) 792-5500

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684800000000",
    "number": "1114619657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4617 SUMMERHILL RD STE 3",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032783",
            "telephone_number": "039-838-5506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4617 SUMMERHILL RD STE 3",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032783",
            "telephone_number": "903-838-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL A. ELLIS, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "903-838-5506",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; 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.