Kayla Marie Ellis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14773 Issued in MN

Practice address

7150 Valley Creek PLZ Ste 230
Saint Paul, MN 55125-2271

Phone

(651) 217-8296

NPI assigned

May 23, 2022

Last updated

Jun 17, 2022By the provider in NPPES

Sex

Female

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dentists of Woodbury, PC

  dba Dentists of Woodbury

  • Dentist
  • Woodbury, MN
  • NPI 1972165678
  NPD (past)

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

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1891433553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "753 CRESTVIEW DR N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551193280",
            "telephone_number": "952-715-1293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 VALLEY CREEK PLZ STE 230",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551252271",
            "telephone_number": "651-217-8296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KAYLA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucy Sophia Ellingson
• Megan Kathleen Ellingson, CHW
• Taylor Leigh Ellingson, PT
• Sarah Beth Elliott, OTR/L
• Jasmine Ellis
• Thomas Kevin Ellis, CRNA
• Thomas Matthew Ellis, MA LMFT
• Heather Ellsworth, MD
• Ahmed Elmi
• Elmi Abdulaziz Elmi

• Dentist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; 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.