Ethan Matthew Ellis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

39621 Issued in TX

Practice address

1210 E 8TH St Ste 2
Weslaco, TX 78596-7120

Phone

(956) 969-2591

Fax

(956) 969-3855

NPI assigned

Jun 14, 2023

Last updated

Jun 10, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Javier O. de la Garza, DDS, PA

  • General Practice Dentistry
  • Weslaco, TX
  • NPI 1275728909
  NPD

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

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1386328979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1714 STRAWBERRY HL",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "785417901",
            "telephone_number": "940-521-8210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 E 8TH ST STE 2",
            "city": "WESLACO",
            "state": "TX",
            "postal_code": "785967120",
            "telephone_number": "956-969-2591",
            "fax_number": "956-969-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ETHAN",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-14",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "39621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• El Rey Primary Health Care, LLC.
• El Shaddai International Christian Center (Mi Pueblito de Belen)
• Eldercare Properties LTD
• Ramon Eduardo Elizondo Romo, M.D.
• Veronica Elizondo
• Emerge DME LLC
• Empowering Minds Counseling Services PLLC
• Encino Primary Home Care LLC
• Mario Salvador Escalante, M.D.
• Djomelle Escano, CRNA

• General Practice Dentistry in Weslaco, TX
• Providers in Weslaco, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.