Susan Ellison DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

15975 Issued in TX

Legal business name

SUSAN ELLISON DDS PC

Practice address

12850 Jones Rd
# 103
Houston, TX 77070

Phone

(281) 890-2828

Fax

(281) 897-9793

NPI assigned

May 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Susan Ellison Ketterer, DDS

Title

Owner Dentist

Phone

(281) 890-2828

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Ellison, DDS

  • Dentist
  • Houston, TX
  • NPI 1861642092
  NPD (past)

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427270552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12850 JONES RD",
            "address_2": "# 103",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77070",
            "telephone_number": "281-890-2828",
            "fax_number": "281-897-9793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12850 JONES RD",
            "address_2": "# 103",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77070",
            "telephone_number": "281-890-2828",
            "fax_number": "281-897-9793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN ELLISON DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KETTERER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "ELLISON",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "281-890-2828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "15975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Hari Krishna Susarla, M.D.
• Sarat Chandra Susarla, MD
• Hannah Susman, RBT

• Dentist in Houston, TX
• Providers in Houston, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.