Marylucy Elema, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE61088351 Issued in WA

Practice address

445 Centennial Ave
Butte, MT 59701-2870

Phone

(406) 234-0757

NPI assigned

Apr 11, 2019

Sex

Female

Sole proprietor

Yes

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

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: melema348825@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Butte Silver Bow Primary Health Care Clinic Inc

  dba Blacktail Dental

  • Federally Qualified Health Center (FQHC)
  • Dillon, MT
  • NPI 1235238718
  NPD (past)

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1467915892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 CENTENNIAL AVE",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597012870",
            "telephone_number": "406-723-4075",
            "fax_number": "406-723-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 CENTENNIAL AVE",
            "city": "BUTTE",
            "state": "MT",
            "postal_code": "597012870",
            "telephone_number": "406-234-0757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 E Glendale St",
            "address_purpose": "LOCATION",
            "city": "Dillon",
            "state": "MT",
            "postal_code": "597252506",
            "country_code": "US",
            "telephone_number": "406-988-0266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELEMA",
        "first_name": "MARYLUCY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61088351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colin Edenholm, RPH
• Amber Rae Edwards, FNP-C, APRN
• Questa M Edwards, OTR/L
• Allison Katherine Eisenzimer, PHARMD
• Stephanie Eissinger, LCPC
• Elevate Counseling PLLC
• Elevation Dental Butte PLLC
• Sadie Rae Ellingson, LCPC
• Jan Ellis, LCSW
• William Bruce Ellis, M.D.

• General Practice Dentistry in Butte, MT
• Providers in Butte, MT by specialty
• General Practice Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.