NPIMap

Spencer a. Ellis

Organization Active NPI General Practice Dentistry · Huntsville, TN

NPI 1194900464 · NPPES record last updated Oct 2, 2023

Key facts

NPI
1194900464
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
License
DS7646 (TN)
Legal business name
SPENCER A. ELLIS
Practice address
170 Scott High Dr
Huntsville, TN 37756-4152
Phone
(423) 663-4444
Fax
(423) 663-4439
NPI assigned
Jan 7, 2008
Organization subpart
No

Authorized official

Name
Spencer A. Ellis, D.D.S. NPI 1992821763
Title
Owner
Phone
(423) 663-4444

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

Practitioners 2

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

National Provider Directory

Locations

170 Scott High Dr
Huntsville, TN 37756
Phone (423) 663-4444

459 Industrial Ln
Oneida, TN 37841
Phone (423) 569-3456

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193200000X MULTI-SPECIALTY GROUP		 1223G0001X DS7646 TN Yes
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

170 Scott High Dr
Huntsville, TN 37756-4152

Mailing address

PO Box 209
Huntsville, TN 37756-0209
Phone (423) 663-4444

Other identifiers

IdentifierTypeStateIssuer
3139906OtherTNBLUE CROSS BLUE SHEILD

Other names

  • Ellis Family Dentistry Doing business as

Other providers in Huntsville, TN

All providers in Huntsville, TN · General Practice Dentistry in Tennessee

Sources for this page

Verify at the official NPI Registry.