NPIMap

Organization Active NPI

Scott Ellard Dentistry

  • Dentist
  • Portage, MI
National Provider Identifier
1124098942
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12873 Issued in MI
Legal business name
SCOTT ELLARD DENTISTRY
Practice address
5835 Oakland Drive
Portage, MI 49024
Phone
(269) 329-1880
Fax
(269) 329-1886
NPI assigned
Jan 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Scott F Ellard, DDS
Title
Owner
Phone
(269) 329-1880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12873 MI Primary

Addresses

Primary practice location

5835 Oakland Drive
Portage, MI 49024

Mailing address

5835 Oakland Drive
Portage, MI 49024
Phone (269) 329-1880

National Provider Directory

National Provider Directory

Locations

5835 Oakland Dr
Portage, MI 49024
Phone (269) 225-0503

Practitioners & affiliated clinicians

Practitioners 1

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": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124098942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5835 OAKLAND DRIVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "49024",
            "telephone_number": "269-329-1880",
            "fax_number": "269-329-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5835 OAKLAND DRIVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "49024",
            "telephone_number": "269-329-1880",
            "fax_number": "269-329-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT ELLARD DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLARD",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-329-1880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "12873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.