David Michael Ellis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5098 Issued in LA

Practice address

17583 Old Jefferson Hwy
Prairieville, LA 70769-3930

Phone

(225) 673-2200

NPI assigned

Jul 31, 2008

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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

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

• Ellis Dental Care

  • General Practice Dentistry
  • Prairieville, LA
  • NPI 1710092937
  NPD (past) Authorized official

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

{
    "created_epoch": "1217462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423526400000",
    "number": "1548426448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17583 OLD JEFFERSON HWY",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707693930",
            "telephone_number": "225-673-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17583 OLD JEFFERSON HWY",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707693930",
            "telephone_number": "225-673-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "DAVID",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-31",
        "last_updated": "2015-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL DENTISTRY",
            "identifier": "721425524",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby Lynn Edmonston, BCBA, LBA
• Adrianne Netterville Edmundson, M.D.
• Amber Nicole Edwards
• Egt Counseling & Consulting Services, LLC
• Ellis Dental Care
• Emerald Medical Supply
• Misty Entremont
• Essential Occupational Health and Safety V, LLC
• Brett A Evans
• Kristen Eymard

• General Practice Dentistry in Prairieville, LA
• Providers in Prairieville, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; 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.