Mona TW Ellis, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2103 Issued in SC

Practice address

1289 Boulevard St
Orangeburg, SC 29115-3401

Phone

(803) 533-0626

Fax

(803) 533-0627

NPI assigned

Nov 7, 2006

Last updated

Jul 8, 2007By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962571687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1289 BOULEVARD ST",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291153401",
            "telephone_number": "803-533-0626",
            "fax_number": "803-533-0627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1289 BOULEVARD ST",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291153401",
            "telephone_number": "803-533-0626",
            "fax_number": "803-533-0627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MONA",
        "middle_name": "TW",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "2103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZ2103",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edna C Jackson Institute of Healthcare Education
• Lellan Dawes Edwards, D.M.D., M.S.
• Sonya Kay Ehrhardt, RN, DNP
• Sherry L Eisom, MN
• Jeremy Morry Eith, ATC
• Tanisha Patrice Elmore, CCC-SLP
• Anne Epting, MD
• Lee A Erbe, NP
• Thomas J Erickson, RPH
• Frank Estes, RPH

• Dentist in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.