Ellis Orthodontics, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12009958A Issued in IN

Legal business name

ELLIS ORTHODONTICS, LLC

Practice address

275 US Highway 30
Suite 260
Dyer, IN 46311-1776

Phone

(219) 322-7645

NPI assigned

Aug 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lawrence Charles Ellis, DDS, MSDNPI 1932381415

Title

Orthodontist

Phone

(219) 322-7645

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lawrence C. Ellis, DDS, MSD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Dyer, IN
  • NPI 1932381415
  NPD (past) Authorized official
• Ketti R Boller, D.D.S, M.S

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Crown Point, IN
  • NPI 1255682662
  NPD (past)

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1700070331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 US HIGHWAY 30",
            "address_2": "SUITE 260",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111776",
            "telephone_number": "219-322-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 US HIGHWAY 30",
            "address_2": "SUITE 260",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111776",
            "telephone_number": "219-322-7645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS ORTHODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "219-322-7645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12009958A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dyer Dental, LLC
• Dyer Family Dental Inc.
• Dyer Family Dentistry
• Dyer Medical Center, Inc.
• Dyer Volunteer Fire Department
• Lawrence C. Ellis, DDS, MSD
• Ameer Elsalaymeh
• Rama Embar, M.D.
• Empowerme Rehabilitation, LLC
• Lori R. Enevoldsen, D.C.

• Orthodontics and Dentofacial Orthopedics Dentistry in Dyer, IN
• Providers in Dyer, IN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.