Michael Barry Ellis, D.M.D.,P.A.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

204783 Issued in MS

Practice address

1008 Mission Park Dr
Vicksburg, MS 39180-3735

Phone

(601) 629-4100

Fax

(601) 629-4101

NPI assigned

Jul 17, 2006

Last updated

Jul 8, 2007By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Morgan Dentistry, PA

  dba Ellis & Morgan Family Dentistry

  • Dentist
  • Vicksburg, MS
  • NPI 1972056240
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619995743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 MISSION PARK DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803735",
            "telephone_number": "601-629-4100",
            "fax_number": "601-629-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MISSION PARK DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803735",
            "telephone_number": "601-629-4100",
            "fax_number": "601-629-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MICHAEL",
        "middle_name": "BARRY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.,P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "204783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terriaunce Edwards
• Kimberly Lynn Eldridge, MSN, FNP-BC, CWCN
• Elite Performance and Rehab, LLC
• Danny Ellis, NP
• Kaitlyn Ellis, D.M.D.
• Angela Kelley Elllis
• Margaret Ellzey-Nichols, D.M.D
• Sharon Elverton, PCMHT
• Tammy Carol English, PT, DPT
• Jeffrey Erickson

• General Practice Dentistry in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.