Cherryl Sue Ellison, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

104713 Issued in CA

Practice address

105 Community Dr Ste a
Seymour, IN 47274-1955

Phone

(812) 272-4602

NPI assigned

May 30, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Green Lake Family and Cosmetic Dentistry

  • Dental Clinic/Center
  • Seattle, WA
  • NPI 1992506141
  NPD Authorized official

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1407414956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3312 E ROY SCHMALZ CT",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 COMMUNITY DR STE A",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472741955",
            "telephone_number": "812-272-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "CHERRYL",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-30",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12013148A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "104713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Drawbaugh, LMHC
• Lynnelle Driver, PA-C
• Catherine Mary Dubois, EDS, LMHC, NCC
• Jordan Leigh Duchi, COTA
• Keegan Ehlers, PHARMD
• Enhance, Inc.
• Phillip M Estep, NP
• Taylor Estep
• Everside Health, LLC
• Everside Health, LLC

• General Practice Dentistry in Seymour, IN
• Providers in Seymour, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; 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.