Mark Allen Ellis, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

12010547A Issued in IN

Practice address

910 Averitt Rd
Greenwood, IN 46143-9540

Phone

(317) 859-9450

Fax

(317) 859-9475

NPI assigned

Oct 4, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Ellis Pediatric Dentistry

  • Pediatric Dentistry
  • Greenwood, IN
  • NPI 1942142286
  NPD Authorized official

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544659200000",
    "number": "1184719262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 AVERITT RD",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461439540",
            "telephone_number": "317-859-9450",
            "fax_number": "317-859-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 AVERITT RD",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461439540",
            "telephone_number": "317-859-9450",
            "fax_number": "317-859-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARK",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2018-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12010547A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200500300",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Isabel Elleman
• Alishia Elliott, MA, NCC, LMHCA
• Jill M Elliott, MS, OTR
• Ellis Pediatric Dentistry
• Abby Foster Ellis, OTR
• Paul Ellis, M.D., M.S.D.
• Ashley Ellison, RBT
• Scott W Ellrich
• Tamara Geralyn Elsner
• Elvaris Medical LLC

• Pediatric Dentistry in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Pediatric Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2018; 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.