Thomas Alan Ellisor, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

28931 Issued in TX

Practice address

103 N Dixie Dr
Lake Jackson, TX 77566-5940

Phone

(979) 297-6438

NPI assigned

May 28, 2013

Last updated

May 28, 2013By the provider in NPPES

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

Opted out of Medicare

Yes, effective Apr 13, 2021 through Apr 13, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Lake Jackson Family Dentistry PLLC

  • Dental Clinic/Center
  • Lake Jackson, TX
  • NPI 1386351062
  NPD Authorized official
• Cynthia Overholser DDS

  dba Lake Jackson Family Dentistry

  • Dental Clinic/Center
  • Lake Jackson, TX
  • NPI 1134450034
  NPD (past)

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

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369699200000",
    "number": "1649617838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 W PHILLIPS RD",
            "city": "ANGLETON",
            "state": "TX",
            "postal_code": "775159370",
            "telephone_number": "254-495-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N DIXIE DR",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775665940",
            "telephone_number": "979-297-6438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISOR",
        "first_name": "THOMAS",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-28",
        "last_updated": "2013-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "28931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eco Dental Care, PLLC
• Sara Eddy
• Brooksie Edquist, PT
• Steven Dale Eggleston, M.D.
• Elite Healthcare Services, PLLC
• Scott A Elrod
• Emerardo Falcon Jr., M.D., P.a.
• Courtney Ayana Ennis, PHARMD
• Raquel Enriquez
• Andrea Michele Estepp

• Dentist in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.