Organization Active NPI

DRS. Ellis & Mefford Dental Associates, PLLC

  • General Practice Dentistry
  • Johnson City, TN
National Provider Identifier
1619092152
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS007966 Issued in TN
Legal business name
DRS. ELLIS & MEFFORD DENTAL ASSOCIATES, PLLC
Practice address
2806 W Market St
Johnson City, TN 37604-5166
Phone
(423) 434-1370
Fax
(423) 434-9965
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Milton Keith Ellis, D.D.S.
Title
Doctor
Phone
(423) 434-1370

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DS004187 TN
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DS007966 TN Primary

Addresses

Primary practice location

2806 W Market St
Johnson City, TN 37604-5166

Mailing address

2806 W Market St
Johnson City, TN 37604-5166
Phone (423) 434-1370

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619092152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2806 W MARKET ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045166",
            "telephone_number": "423-434-1370",
            "fax_number": "423-434-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2806 W MARKET ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376045166",
            "telephone_number": "423-434-1370",
            "fax_number": "423-434-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. ELLIS & MEFFORD DENTAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MILTON",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "423-434-1370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS004187",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS007966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.