Jessica Mae Ellsperman, DDS
Individual provider Active NPI General Practice Dentistry · Sullivan, IN
NPI 1912436635 · NPPES record last updated Jun 6, 2017
Key facts
- NPI
- 1912436635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12012696B (IN)
- Practice address
- 2186 N Hospital Blvd # 1
Sullivan, IN 47882-7654 - Phone
- (812) 268-4010
- NPI assigned
- Jun 6, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12012696B | IN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sullivan Family Dentistry, LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12012696B | IN | Yes |
Addresses
Primary practice location
2186 N Hospital Blvd # 1
Sullivan, IN 47882-7654
Mailing address
10812 N Old 41
Oaktown, IN 47561-8015
Phone (812) 499-3465
Other providers in Sullivan, IN
- Jessica A Dean-Hester
- Susan H. Doty
- Ernest Steve Dupre
- Robert Ealy
- Dustin Clay Ellis
- Emerald Health & Wellness LLC
- Van Evanoff Jr.
- Kevin Braun Flinn
- Michelle D Gill
- Destiny Nicole Goldner
All providers in Sullivan, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.