Brandon Keith Ellis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12508 Issued in MD

Practice address

19638 Leitersburg Pike Ste 103
Hagerstown, MD 21742-1516

Phone

(301) 739-1100

NPI assigned

Aug 22, 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

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.

• Longmeadow Family Dental Care

  • General Practice Dentistry
  • Hagerstown, MD
  • NPI 1174637185
  NPD (past) Authorized official

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509321600000",
    "number": "1578679643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19638 LEITERSBURG PIKE",
            "address_2": "SUITE 103",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19638 LEITERSBURG PIKE STE 103",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217421516",
            "telephone_number": "301-739-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BRANDON",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2017-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "12508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elite Performance Institute LLC
• Ellington Eyecare PLLC
• Kennalee Elliott, MPAS, PA-C
• Shelby Hope Elliott, LCPC
• Amber Ellis, CNA, GNA
• Mark J Ellis
• Megan Danielle Ellis, LPN
• Vicki Ellis, MD
• Kezia Lynnette Ellison, MD
• Nia Imani Elmore

• Dentist in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; 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.