Ellis Jardine, DMD, PLLC

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

DE 60339865 Issued in WA

Legal business name

ELLIS JARDINE, DMD, PLLC

Doing business as

Excel Dental

Practice address

1401 NW 1St St Ste 120
Battle Ground, WA 98604-4540

Phone

(360) 666-5700

Fax

(360) 666-5701

NPI assigned

Feb 18, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ellis Burke Jardine, DMDNPI 1922205715

Title

Owner

Phone

(480) 862-3185

Specialties & licenses 1

Addresses

Other names 1

• Excel Dental Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ellis Burke Jardine, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Vancouver, WA
  • NPI 1922205715

  Prosthodontics

  Medicare reassignment NPD Authorized official
• Hodeis Tabatabaei-Moghaddam, DDS

  • Dentist
  • Battle Ground, WA
  • NPI 1194243725
  NPD (past)

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455753600000",
    "number": "1831558907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 NW 1ST ST STE 120",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986044540",
            "telephone_number": "360-666-5700",
            "fax_number": "360-666-5701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 NW 1ST ST STE 120",
            "city": "BATTLE GROUND",
            "state": "WA",
            "postal_code": "986044540",
            "telephone_number": "360-666-5700",
            "fax_number": "360-666-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS JARDINE, DMD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-18",
        "last_updated": "2016-02-18",
        "status": "A",
        "authorized_official_last_name": "JARDINE",
        "authorized_official_first_name": "ELLIS",
        "authorized_official_middle_name": "BURKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-862-3185",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "WA",
            "license": "DE 60339865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excel Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jordan Nathaniel Ek, MPT
• Courtney L Elton, MD
• Enrichiv
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• Prosthodontics in Battle Ground, WA
• Providers in Battle Ground, WA by specialty
• Prosthodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.