Active NPI
Bruce G. Ellis, D.D.S.
- Dentist
- Glendale, CA
National Provider Identifier
1316018328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22795
- Practice address
- 3424 N. Verdugo Rd.
Glendale, CA 91208 - Phone
- (818) 248-2295
- Fax
- (818) 248-3285
- NPI assigned
- Nov 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22795 | CA | Primary |
Addresses
Primary practice location
3424 N. Verdugo Rd.
Glendale, CA 91208
Mailing address
3424 N. Verdugo Rd.
Glendale, CA 91208
Phone (818) 248-2295
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22795 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460332800000",
"number": "1316018328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3424 N. VERDUGO RD.",
"city": "GLENDALE",
"state": "CA",
"postal_code": "91208",
"telephone_number": "818-248-2295",
"fax_number": "818-248-3285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3424 N. VERDUGO RD.",
"city": "GLENDALE",
"state": "CA",
"postal_code": "91208",
"telephone_number": "818-248-2295",
"fax_number": "818-248-3285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "BRUCE",
"middle_name": "G.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-13",
"last_updated": "2016-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "22795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
- Ella Home Health Care Inc
- Deeanna Lee Eller, ROH
- Ellie Bloomfield MD
- Elliot Home Care
- Aileen Hitomi Ellis, COTA/L
- Margaret Louise Donnelly Ellis
- Elmira Recuperative Care LLC
- Ranell Elmore
- Elms Sanitarium Inc (Elms Convalescent Hospital)
- Elrose Anesthesia Services Inc (Elrose Anesthesia Services Inc a Medical Corporation)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.