NPIMap

Organization Active NPI

Ellingsen Henneberg PLLC

  • Dentist
  • Spokane, WA
National Provider Identifier
1841845211
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ELLINGSEN HENNEBERG PLLC
Practice address
6817 N Cedar Rd Ste 201
Spokane, WA 99208-4277
Phone
(509) 326-8170
NPI assigned
Aug 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Authorized official

Name
Dr. Eric Ellingsen, DDSNPI 1245453265
Title
Owner
Phone
(509) 924-2866

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

6817 N Cedar Rd Ste 201
Spokane, WA 99208-4277

Mailing address

1215 N McDonald Rd Ste 203
Spokane Valley, WA 99216-1557
Phone (509) 924-2866

Other names 2

  • Smile Source North Doing business as
  • Smile Source Spokane Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ellingsen Henneberg PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1564704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564704000000",
    "number": "1841845211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 N MCDONALD RD STE 203",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161557",
            "telephone_number": "509-924-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6817 N CEDAR RD STE 201",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992084277",
            "telephone_number": "509-326-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLINGSEN HENNEBERG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-02",
        "last_updated": "2019-08-02",
        "status": "A",
        "authorized_official_last_name": "ELLINGSEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-924-2866",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Source North",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Smile Source Spokane",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; 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.