Larisa Ellis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

009502 Issued in CT

Practice address

263 Main St
Old Saybrook, CT 06475-2326

Phone

(860) 388-4433

Fax

(860) 388-4434

NPI assigned

Jan 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1881664514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 MAIN ST",
            "address_2": "ATTN: CREDENTIALING DEPARTMENT",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572718",
            "telephone_number": "860-347-6971",
            "fax_number": "860-638-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 MAIN ST",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064752326",
            "telephone_number": "860-388-4433",
            "fax_number": "860-388-4434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "LARISA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "009502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236354",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Ann Duperry, APRN
• East Coast Anesthesia
• Robert Ladd Edmonstone, DDS
• Matthew E Elgart, OD
• Monya D Elgart, OD
• Peter Elman, RPH,PD
• Elmwood and Main Dentistry LLC
• Adam E. M. Eltorai, MD, PHD
• Beth May Embleton, MSW, LCSWA
• Erin E Murphy, LLC

• General Practice Dentistry in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.