Fred Ray Ellis Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DSO22283L Issued in PA

Practice address

233 S. Pleasant Ave.
#303
Somerset, PA 15501-2188

Phone

(814) 445-4636

Fax

(814) 445-1018

NPI assigned

Jul 20, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1780604801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 S. PLEASANT AVE.",
            "address_2": "#303",
            "city": "SOMERSET",
            "state": "PA",
            "postal_code": "155012188",
            "telephone_number": "814-445-4636",
            "fax_number": "814-445-1018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 S. PLEASANT AVE.",
            "address_2": "#303",
            "city": "SOMERSET",
            "state": "PA",
            "postal_code": "155012188",
            "telephone_number": "814-445-4636",
            "fax_number": "814-445-1018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "FRED",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DSO22283L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPA",
            "identifier": "0801431",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DSO22283L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Dunmyer
• Marsha Dykstra, MS
• Kelly A Eaglehouse, CRNA
• Laura Lee Eagler
• Amy Eckman, LAT, ATC
• Sherif M Eltawansy, M.D.
• Emerge Counseling Services LLC
• Martha Lavan Emerick, MS, LPC, NCC
• Karen Emert, OTA/L
• Mary Alice Emert, LCSW

• General Practice Dentistry in Somerset, PA
• Providers in Somerset, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.