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

Last updated

Feb 22, 2012By the provider in NPPES

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

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.

• Southwestern Smile Design, LLC

  dba Mountain View Dentistry

  • Dental Clinic/Center
  • Surprise, AZ
  • NPI 1437394731
  Authorized official Same address or phone

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": []
}

• Vanessa Fernandez Eller, MD
• Lee Ellershaw, PHARM D.
• William Ellert, MD
• Traci Ellery, MS, ATC
• Lori Ellezian
• 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.