Jerry R Ellis DDS PC – Customized Equipment (DME)

Key facts

NPI: 1982304267
Entity type: Organization (NPI type 2)
Primary specialty: Customized Equipment (DME) 332BC3200X
Legal business name: JERRY R ELLIS DDS PC
Practice address: 404 W Main St
Midlothian, TX 76065-2946
Phone: (972) 775-2345
NPI assigned: Mar 6, 2023
Organization subpart: No

Authorized official

Name: Dr. Jerry R Ellis, DDS
Title: Owner/Dentist
Phone: (972) 775-2345

National Provider Directory

Locations

404 W Main St
Midlothian, TX 76065
Phone (972) 775-2345

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dental Clinic/Center	261QD0000X
Customized Equipment (DME)	332BC3200X			Yes

Addresses

Primary practice location

404 W Main St
Midlothian, TX 76065-2946

Mailing address

404 W Main St
Midlothian, TX 76065-2946
Phone (972) 775-2345

Other names

Jerry R Ellis DDS PC Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 20, 2023.

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1982304267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W MAIN ST",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760652946",
            "telephone_number": "972-775-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W MAIN ST",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760652946",
            "telephone_number": "972-775-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY R ELLIS DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "972-775-2345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jerry R Ellis DDS PC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jerry R Ellis DDS PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Midlothian, TX

All providers in Midlothian, TX · Customized Equipment (DME) in Texas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2023. 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.

Verify at the official NPI Registry.