Ellingsen Henneberg PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ELLINGSEN HENNEBERG PLLC

Doing business as

Smile Source Spokane

Practice address

2607 S Southeast Blvd Ste B210
Spokane, WA 99223-7614

Phone

(509) 924-2866

NPI assigned

Oct 16, 2020

Organization subpart

Yes

Parent organization

ELLINGSEN HENNEBERG PLLCAs reported in NPPES

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

Authorized official

Name

Eric C Ellingsen, DDSNPI 1245453265

Title

Owner

Phone

(509) 924-2866

Specialties & licenses 1

Addresses

Other names 1

• Smile Source Spokane Doing business as

Tax ID family

Ellingsen Henneberg PLLC2 organizations share this tax ID, including this one

Part of

Ellingsen Henneberg PLLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ellingsen Henneberg PLLC

  dba Smile Source North

  • Dentist
  • Spokane, WA
  • NPI 1841845211
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Ellingsen Henneberg PLLC

  dba Smile Source North

  • Dentist
  • Spokane, WA
  • NPI 1841845211
  NPPES parent name

Practitioners 1

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

• Eric C Ellingsen, DDS

  • General Practice Dentistry
  • Spokane Valley, WA
  • NPI 1245453265
  NPD Authorized official

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

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1215535695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 N MCDONALD RD STE 203",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161557",
            "telephone_number": "509-924-2866",
            "fax_number": "509-924-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2607 S SOUTHEAST BLVD STE B210",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992237614",
            "telephone_number": "509-924-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLINGSEN HENNEBERG PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELLINGSEN HENNEBERG PLLC",
        "enumeration_date": "2020-10-16",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "ELLINGSEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-924-2866",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Source Spokane",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smile Source Spokane",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cody Joshua Ellefsen, DO
• Seth Andrew Ellenz, MS CANDIDATE
• Bridget Rae Eller
• Grace Elizabeth Ellersick
• Blake Ellert, MS
• Ellingsen Henneberg PLLC (Smile Source North)
• Donald E Ellingsen, M.D.
• Ronald H. Ellingsen, D.D.S.,M.S.D.
• Tammy R. Ellingsen, MD
• Riann Ellingwood, MS

• Dental Clinic/Center in Spokane, WA
• Providers in Spokane, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.