Matthew Ryan Ellis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14822 Issued in MN

Practice address

8454 Highway 7
St Louis Park, MN 55426-3900

Phone

(952) 933-3667

NPI assigned

Aug 10, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Knollwood Dentistry, PC

  dba Knollwood Dentistry

  • General Practice Dentistry
  • St Louis Park, MN
  • NPI 1497149496
  NPD (past)

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1639694672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5389 EMPIRE LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463916",
            "telephone_number": "949-769-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8454 HIGHWAY 7",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263900",
            "telephone_number": "952-933-3667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MATTHEW",
        "middle_name": "RYAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-10",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101852",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Wagner, PSYD, LP, Inc. (ELEOS Psychology Center)
• Danielle Mary Becker Ellingson, PHD
• Mary Ellingson, RN
• Georgianna Faye Elliott, REGISTERED DIETITIAN
• Ellipsis Mental Health, PLLC
• Paul Russell Ellison, PSYD, LP
• Elm Creek Healthcare Inc
• Eugene Elvecrog
• Kristine Lynn Elvrum, RN
• Mariah Elizabeth Emerson, PT

• Dentist in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; 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.