NPIMap

Organization Active NPI

South Sound Dentures,PS

Doing business as South Sound Dental & Dentures

  • Dentist
  • Olympia, WA
National Provider Identifier
1669768545
Registry record updated Jun 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE10844 Issued in WA
Legal business name
SOUTH SOUND DENTURES,PS
Doing business as
South Sound Dental & Dentures
Practice address
2728 Westmoor CT SW Ste a
Olympia, WA 98502-5779
Phone
(360) 709-9909
Fax
(360) 491-3883
NPI assigned
Jun 20, 2011
Last updated
Jun 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2011

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

Authorized official

Name
Fred E Ellis, DPDNPI 1891835310
Title
Owner/President
Phone
(360) 709-9909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DE10844 WA Primary

Addresses

Primary practice location

2728 Westmoor CT SW Ste a
Olympia, WA 98502-5779

Mailing address

2728 Westmoor CT SW Ste a
Olympia, WA 98502-5779
Phone (360) 709-9909

Other names 1

  • South Sound Dental & Dentures Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308528000000",
    "number": "1669768545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2728 WESTMOOR CT SW STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025779",
            "telephone_number": "360-709-9909",
            "fax_number": "360-491-3883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2728 WESTMOOR CT SW STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025779",
            "telephone_number": "360-709-9909",
            "fax_number": "360-491-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SOUND DENTURES,PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-06-20",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "360-709-9909",
        "authorized_official_credential": "DPD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE10844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Sound Dental & Dentures",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; 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.