Randall A. Ellis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3050 Issued in AR

Practice address

312 Arkansas Blvd
Texarkana, AR 71854-1905

Phone

(870) 772-1374

Fax

(870) 774-6814

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

Yes

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

State licenses

Practice roles

Locations

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.

• Randall a. Ellis, DDS, PLLC

  • General Practice Dentistry
  • Texarkana, AR
  • NPI 1336831874
  NPD Authorized official
• Randall a. Ellis, DDS, PLLC

  • General Practice Dentistry
  • Texarkana, TX
  • NPI 1114619657
  NPD Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740328046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 ARKANSAS BLVD",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541905",
            "telephone_number": "870-772-1374",
            "fax_number": "870-774-6814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 ARKANSAS BLVD",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541905",
            "telephone_number": "870-772-1374",
            "fax_number": "870-774-6814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "RANDALL",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler E. Edge, LAC
• Danette Eggers
• Eh Home Health of East Texas, LLC
• Elara Caring PCS Ar LLC
• Hayden Ellis, DDS
• Sedrick L Ervin, MHPP
• Crystal Evans, LPC
• Evans' Counseling and Psycho-Educational Firm, Inc
• Patrick Ezihe, PHARM D
• Kaiyang Feng, DO

• General Practice Dentistry in Texarkana, AR
• Providers in Texarkana, AR by specialty
• General Practice Dentistry in Arkansas

• 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.