Michael Lynn Ellis, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DT2031 Issued in HI

Practice address

24 N Church St
Suite 206
Wailuku, HI 96793-1680

Phone

(808) 242-0077

Fax

(808) 243-8004

NPI assigned

Jan 15, 2007

Last updated

May 12, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1487705695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 N CHURCH ST",
            "address_2": "SUITE 206",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931680",
            "telephone_number": "808-242-0077",
            "fax_number": "808-243-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 N CHURCH ST",
            "address_2": "SUITE 206",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967931680",
            "telephone_number": "808-242-0077",
            "fax_number": "808-243-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MICHAEL",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "HI",
            "license": "DT2031",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "14623",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Marie Ehrecke, PA-C
• William T Eilert, MD
• Irwin P Eli, DC
• Ellen R. Caringer PHD Inc.
• Susann Elliott
• Kate Hannah Elson, PA-C
• Marc S Emde, MD
• Patti K.M. Endo, M.D.
• Lawrence Michael Eng, AUD
• Cameron Edward English, DPT

• Oral and Maxillofacial Surgery (Dentist) in Wailuku, HI
• Providers in Wailuku, HI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; 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.