Taylor Austin Ellson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11324 Issued in OR

Practice address

21300 Highway 62
Shady Cove, OR 97539-7707

Phone

(541) 878-2115

Fax

(541) 878-2117

NPI assigned

Sep 16, 2020

Last updated

Sep 16, 2020By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gold Hill Family Dentistry, LLC

  • General Practice Dentistry
  • Gold Hill, OR
  • NPI 1760017263
  NPD
• Shady Cove Family Dentistry

  • General Practice Dentistry
  • Shady Cove, OR
  • NPI 1376819656
  NPD (past)

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1164038030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1150",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "975391150",
            "telephone_number": "541-878-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 HIGHWAY 62",
            "city": "SHADY COVE",
            "state": "OR",
            "postal_code": "975397707",
            "telephone_number": "541-878-2115",
            "fax_number": "541-878-2117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSON",
        "first_name": "TAYLOR",
        "middle_name": "AUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-16",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Orlinda Mae Delk, BA
• Kristin Carol Diasio, MS SPECIAL EDUCATION
• Direct Physical Therapy, LLC
• Valerie June Dubois, LCSW
• Gina Eilertson, D.C.
• Kathleen Finley
• Kristen Ranae Gerhardt
• Rhonda Grayson
• Kathleen S Finley (Shady Cove Clinic)
• Kelly Clayton FNP Inc (Health Care By House Call)

• General Practice Dentistry in Shady Cove, OR
• Providers in Shady Cove, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.