Dr. Eda Ellis Dental PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DR. EDA ELLIS DENTAL PC

Practice address

30 Central Park S
Suite 7a
New York, NY 10019-1628

Phone

(212) 753-1119

Fax

(212) 753-1139

NPI assigned

Apr 19, 2017

Organization subpart

No

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

Authorized official

Name

Eda Ellis

Title

Owner

Phone

(212) 753-1119

Specialties & licenses 1

Addresses

Tax ID family

Central Park Dental Spa2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Central Park Dental Spa

  • Dental Clinic/Center
  • New York, NY
  • NPI 1184079477
  NPD tax ID

Locations

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1427582147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CENTRAL PARK S",
            "address_2": "SUITE 7A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191628",
            "telephone_number": "212-753-1119",
            "fax_number": "212-753-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CENTRAL PARK S",
            "address_2": "SUITE 7A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191628",
            "telephone_number": "212-753-1119",
            "fax_number": "212-753-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. EDA ELLIS DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "EDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-753-1119"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.