Wayne R. Ellis, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D-1522 Issued in ID

Practice address

6363 W Emerald St
Building 102
Boise, ID 83704-8783

Phone

(208) 376-6307

Fax

(208) 376-9011

NPI assigned

Aug 25, 2006

Sex

Male

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

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427166024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6363 W EMERALD ST",
            "address_2": "BUILDING 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048783",
            "telephone_number": "208-376-6307",
            "fax_number": "208-376-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 W EMERALD ST",
            "address_2": "BUILDING 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048783",
            "telephone_number": "208-376-6307",
            "fax_number": "208-376-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "WAYNE",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "D-1522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Cody Ellis, LCPC
• Patricia Taylor Ellis, LMSW
• Staci Dawn Ellis, LMT
• Susie Ellis, CPM, LM
• Timothy J. Ellis, O.D.
• Jason M Ellison, MD
• Santina Marie Ellison, M.D.
• Daniel Elmore, CRNA
• Travis Patrick Elmore
• Trina G Elsasser, MCOUN, LCPC, NCC

• Endodontics in Boise, ID
• Providers in Boise, ID by specialty
• Endodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.