Active NPI
Scott Richard Ellis, DDS
- Dentist
- St George, UT
National Provider Identifier
1720343262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8362082
- Practice address
- 444 E Tabernacle St. #1
Saint George, UT 84770 - Phone
- (435) 628-9099
- Fax
- (435) 673-3571
- NPI assigned
- Jul 11, 2012
- Last updated
- Jul 11, 2012
- Sex
- Male
- Sole proprietor
- No
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 | 8362082 | UT | Primary |
Addresses
Primary practice location
444 E Tabernacle St. #1
Saint George, UT 84770
Mailing address
444 E Tabernacle St. #1
Saint George, UT 84770
Phone (435) 628-9099
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 |
|---|---|---|---|
| 8362082 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St George Dental Care LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- St George, UT
- NPI 1891191334
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341964800000",
"number": "1720343262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 E TABERNACLE ST. #1",
"city": "SAINT GEORGE",
"state": "UT",
"postal_code": "84770",
"telephone_number": "435-628-9099",
"fax_number": "435-673-3571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "444 E TABERNACLE ST. #1",
"city": "SAINT GEORGE",
"state": "UT",
"postal_code": "84770",
"telephone_number": "435-628-9099",
"fax_number": "435-673-3571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "SCOTT",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-11",
"last_updated": "2012-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "8362082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.