Active NPI
John Richard Ellenbecker Jr., D.D.S.
- Dentist
- Juneau, AK
National Provider Identifier
1689835050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- AA0546
- Practice address
- 2211 Jordan Ave
Juneau, AK 99801-8050 - Phone
- (907) 789-3696
- Fax
- (907) 789-6852
- NPI assigned
- Jun 18, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | AA0546 | AK | Primary |
Addresses
Primary practice location
2211 Jordan Ave
Juneau, AK 99801-8050
Mailing address
2211 Jordan Ave
Juneau, AK 99801-8050
Phone (907) 789-3696
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD0546 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AA0546 | AK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213747200000",
"number": "1689835050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2211 JORDAN AVE",
"city": "JUNEAU",
"state": "AK",
"postal_code": "998018050",
"telephone_number": "907-789-3696",
"fax_number": "907-789-6852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 JORDAN AVE",
"city": "JUNEAU",
"state": "AK",
"postal_code": "998018050",
"telephone_number": "907-789-3696",
"fax_number": "907-789-6852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENBECKER",
"first_name": "JOHN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-18",
"last_updated": "2008-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "AA0546",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DD0546",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Juneau, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.