Samuel Dwayne Ellsworth, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

25488 Issued in TX

Practice address

6333 E Mockingbird LN
Suite 254
Dallas, TX 75214-2692

Phone

(214) 827-9500

Fax

(214) 827-9502

NPI assigned

Nov 18, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1290038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392681600000",
    "number": "1891097168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 E MOCKINGBIRD LN",
            "address_2": "SUITE 254",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752142692",
            "telephone_number": "214-827-9500",
            "fax_number": "214-827-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 E MOCKINGBIRD LN",
            "address_2": "SUITE 254",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752142692",
            "telephone_number": "214-827-9500",
            "fax_number": "214-827-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "SAMUEL",
        "middle_name": "DWAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-18",
        "last_updated": "2014-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "25488",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "25488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvette Elida Ellis
• Ashleigh Caroline Ellison
• Shevonne Lanette Ellison, NP-C
• Trevor Ashton Ellison, M.D., PH.D., MBA
• Allyson Jeanne Ellman, CPNP-PC
• Luqman Marzouk Ellythy, MD
• Elm Pain Institute
• Nadear A Elmahi, MD
• Jamal Imad Elmakdah
• Sarah Emily Elmer, MD

• Periodontics in Dallas, TX
• Providers in Dallas, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; 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.