Active NPI
Jillian E. Ellison, D.M.D
- Dentist
- Niceville, FL
National Provider Identifier
1972736882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN16159
- Practice address
- 136 Partin Dr N
Niceville, FL 32578-2054 - Phone
- (850) 678-7114
- NPI assigned
- Aug 25, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN16159 | FL | Primary |
| Dentist | 122300000X | 19226 | MA |
Addresses
Primary practice location
136 Partin Dr N
Niceville, FL 32578-2054
Mailing address
136 Partin Dr N
Niceville, FL 32578-2054
Phone (850) 678-7114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN16159 | FL | MD | Dentist |
| 19226 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sharon S Chen DDS PA | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Niceville, FL
- NPI 1700973781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251158400000",
"number": "1972736882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 PARTIN DR N",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325782054",
"telephone_number": "850-678-7114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 PARTIN DR N",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325782054",
"telephone_number": "850-678-7114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "JILLIAN",
"middle_name": "E.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-25",
"last_updated": "2009-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN16159",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "19226",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.