Richard Leroy Ellis III, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

59134909922 Issued in UT

Practice address

5 S 700 E
Suite B-30
Salt Lake City, UT 84102-1135

Phone

(801) 355-3263

NPI assigned

Sep 20, 2006

Sex

Male

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

Enrolled in UT

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

Networks

• UT PPO D-SNP

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154429785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 S 700 E",
            "address_2": "SUITE B-30",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021135",
            "telephone_number": "801-355-3263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 S 700 E",
            "address_2": "SUITE B-30",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021135",
            "telephone_number": "801-355-3263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS III",
        "first_name": "RICHARD",
        "middle_name": "LEROY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "59134909922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karma-Jaya Elliott, MD
• Keith Elliott, MD
• Michael Elliott, ATC
• Paul Elliott
• Richard Leroy Ellis II, DMD
• Abigail Claire Ellis, PT
• Chaston J Ellis, DO
• Gary Lynn Ellis, DDS
• John Gregory Ellis
• Kelsey Ellis

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• 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.
• 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.