Nathanial Preston Ellis, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40938 Issued in TX

Practice address

13236 Northwest Fwy
Houston, TX 77040-6003

Phone

(281) 447-2186

Fax

(281) 447-0892

NPI assigned

Sep 16, 2024

Sex

Male

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

State licenses

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

{
    "created_epoch": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1760219745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16811 DESTREHAN DR",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774296996",
            "telephone_number": "503-209-2870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13236 NORTHWEST FWY",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770406003",
            "telephone_number": "281-447-2186",
            "fax_number": "281-447-0892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "NATHANIAL",
        "middle_name": "PRESTON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "40938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lee M. Ellis, M.D.
• Mariah Ellis
• Matthew J Ellis, MD PHD
• Meredith Bordelon Ellis, CRNA
• Mona Swafford Ellis, LCDC, CHW
• Nicholas David Ellis, PHARMD, RPH
• O'Neka Wheeler Ellis, ACAGNP
• Pshaun Ellis
• Randa Ellis
• Stephanie Ellis, PH.D.

• General Practice Dentistry in Houston, TX
• Providers in Houston, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.