Ellyse Henkle, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.036154 Issued in IL

Practice address

1200 W Jackson St
Macomb, IL 61455-1194

Phone

(309) 836-6688

NPI assigned

Jun 16, 2025

Sex

Female

Sole proprietor

Yes

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

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.

• Lifetime Dental Care of Illinois, PC

  • General Practice Dentistry
  • Macomb, IL
  • NPI 1396967741
  NPD (past)

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

{
    "created_epoch": "1750032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1396631297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 MEADOW DR",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614559320",
            "telephone_number": "708-937-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W JACKSON ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614551194",
            "telephone_number": "309-836-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENKLE",
        "first_name": "ELLYSE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-06-16",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.036154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myrna Lynn Hayes
• Healing Hearts Child & Family Counseling, PLLC
• Heartland of Macomb Il LLC
• Jodi Heller, FNP-C
• Alana Hendrixson, PT, DPT
• Morgan Rae Hentzel
• Nicole Christine Hernandez, PHD
• Manuel Herrera
• Stephen Scott Higgins, PT
• Highland Park CVS LLC

• General Practice Dentistry in Macomb, IL
• Providers in Macomb, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; 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.