Teddy Lynn Ellis, D.D.S.
Individual provider Active NPI General Practice Dentistry · Ft Warren Afb, WY
NPI 1295728756 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295728756
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 06010 (IA)
- Practice address
- 6900 Alden Dr
Ft Warren Afb, WY 82005-3906 - Phone
- (402) 651-1386
- NPI assigned
- Aug 30, 2005
- 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 |
|---|---|---|---|
| 06010 | IA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 06010 | IA | Yes |
Addresses
Primary practice location
6900 Alden Dr
Ft Warren Afb, WY 82005-3906
Mailing address
6900 Alden Drive
Ft Warren Afb, WY 82005
Phone (402) 651-1386
Other providers in Ft Warren Afb, WY
- Matt James Cowan
- Brian Patrick Hayes
- Peggy Sue Kenyon
- James Louis Kretzschmar
- Perala Enterprises, LLC
All providers in Ft Warren Afb, WY · General Practice Dentistry in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.