Mitchell Ward Ellingson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7229 Issued in AZ

Practice address

4530 E Shea Blvd
Phoenix, AZ 85028-6065

Phone

(602) 992-4510

NPI assigned

May 31, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in AZ

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

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329868800000",
    "number": "1497956742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 N FOUNDER CIR",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853963686",
            "telephone_number": "623-377-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 E SHEA BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850286065",
            "telephone_number": "602-992-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "MITCHELL",
        "middle_name": "WARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2012-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "7229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lee Ellershaw, PHARM D.
• William Ellert, MD
• Traci Ellery, MS, ATC
• Lori Ellezian
• Sunanda Ellina, MD
• Henry Dudley Ellington III, P.A.C.
• Patricia Elliot, OTR/L
• Michelle Loy Elliott Smell
• Stacie Elliott-Donison
• Audrey Corsberg Elliott, PMHNP

• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; 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.