Active NPI
Jonathan Hunter Ellis, DDS
- General Practice Dentistry
- Hopewell, VA
National Provider Identifier
1740389451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 0401411395
- Practice address
- 3314 Oaklawn Blvd
Hopewell, VA 23860 - Phone
- (804) 458-6733
- Fax
- (804) 541-0416
- NPI assigned
- Sep 21, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401411395 | VA | Primary |
Addresses
Primary practice location
3314 Oaklawn Blvd
Hopewell, VA 23860
Mailing address
12907 Scrimshaw Circle
Chester, VA 23836
Phone (804) 553-0848
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9182623 | Medicaid | VA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401411395 | VA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740389451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12907 SCRIMSHAW CIRCLE",
"city": "CHESTER",
"state": "VA",
"postal_code": "23836",
"telephone_number": "804-553-0848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3314 OAKLAWN BLVD",
"city": "HOPEWELL",
"state": "VA",
"postal_code": "23860",
"telephone_number": "804-458-6733",
"fax_number": "804-541-0416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JONATHAN",
"middle_name": "HUNTER",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "VA",
"license": "0401411395",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9182623",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hopewell, VA
Sources for this page
- 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.