Kevin John Ellis, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7176 Issued in VA

Practice address

205 34TH St
Suite 112
Virginia Beach, VA 23451-2836

Phone

(757) 428-5491

Fax

(757) 428-7663

NPI assigned

Feb 13, 2006

Sex

Male

Sole proprietor

No

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": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477526069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 LITTLE NECK RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234524740",
            "telephone_number": "757-631-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 34TH ST",
            "address_2": "SUITE 112",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234512836",
            "telephone_number": "757-428-5491",
            "fax_number": "757-428-7663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KEVIN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "7176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alaina Ellis
• April Simone Ellis
• Ashley Omar Ellis
• Claire Ellis
• Donique Ellis
• Pamela Ellis, BS, BSN, CDCES
• Rebecca McLain Ellis, DPT
• Sara Ellis
• Cynthia Sherron Ellison, L.P.C.
• Traci Harp Ellison, PA-C

• General Practice Dentistry in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• General Practice Dentistry in Virginia

• 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.