Richard A. Ellis, DDS
Individual provider Active NPI General Practice Dentistry · Labelle, FL
NPI 1265537633 · NPPES record last updated Apr 30, 2010
Key facts
- NPI
- 1265537633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN6780 (FL)
- Practice address
- 930 S Main St
Labelle, FL 33935-4444 - Phone
- (863) 675-0387
- Fax
- (863) 675-3246
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN6780 | FL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN6780 | FL | Yes |
Addresses
Primary practice location
930 S Main St
Labelle, FL 33935-4444
Mailing address
PO Box 1357
Fort Myers, FL 33902-1357
Phone (239) 278-3600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 074342900 | Medicaid | FL |
Other providers in Labelle, FL
- Mercedes Dominguez Valle
- Janet Dominguez-Giron
- Jenny Garcia Dopico
- Simone Douze-Jeanbaptiste
- Adriana Esther Duarte Constantino
- William Manrique Escobar
- Yadisleidy Exposito
- Daniela Fajardo Rodriguez
- Family Health Centers of Southwest Florida Inc
- Family Health Centers of Southwest Florida, Inc.
All providers in Labelle, FL · General Practice Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.