Lynae D Ellis, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

5282015 Issued in WI

Practice address

1616 N Randall Ave
Janesville, WI 53545-1118

Phone

(608) 754-4998

Fax

(608) 754-5652

NPI assigned

Oct 23, 2006

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pelsue Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Janesville, WI
  • NPI 1295818177

  Orthodontics and Dentofacial Orthopedics

  NPD (past)
• Smile Doctors of Wisconsin, S.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Janesville, WI
  • NPI 1669024667

  Orthodontics and Dentofacial Orthopedics

  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720161789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 N RANDALL AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451118",
            "telephone_number": "608-754-4998",
            "fax_number": "608-754-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 N RANDALL AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451118",
            "telephone_number": "608-754-4998",
            "fax_number": "608-754-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "LYNAE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WI",
            "license": "5282015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanne K Eccles Rotar, MD
• Harlan D Edelman, MD
• Jeremy Edge, APSW
• Madison Egan
• Adrienne Jones Elert, PA-C
• Warren R Ellison, MD
• Jeffrey W Elser
• Empowered Therapy LLC
• Brenda M. Endthoff, CSAC
• Kayla Kristine Engelking, MS, OTR/L

• All providers in Janesville, WI
• Orthodontics and Dentofacial Orthopedics Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.