Mark Alan Ellis, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

9594 Issued in TN

Practice address

951 Riverfront Pkwy
Suite 302
Chattanooga, TN 37402-2185

Phone

(423) 805-7500

Fax

(423) 805-7501

NPI assigned

Sep 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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 and National Provider Directory roles.

• Mark a. Ellis, DMD, PLLC

  • Dentist
  • Chattanooga, TN
  • NPI 1538585161
  NPD (past) Authorized official

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394064000000",
    "number": "1265426894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 RIVERFRONT PKWY",
            "address_2": "SUITE 302",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022185",
            "telephone_number": "423-805-7500",
            "fax_number": "423-805-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 RIVERFRONT PKWY",
            "address_2": "SUITE 302",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374022185",
            "telephone_number": "423-805-7500",
            "fax_number": "423-805-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2014-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "299697",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "9594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doratha Ellis
• Eric R Ellis, M.D.
• Jane Ellis, LCSW
• Jessica Ellis
• Kaitlyn Bayli Ellis
• Mark Andrew Ellis, M.D.
• Patrick Neil Ellis, PHARM.D.
• David F Ellison, DO
• Justin Michael Ellison
• Fred Elmendorf, R.N.

• Dentist in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; 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.