Ellsworth Dental LP

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ELLSWORTH DENTAL LP

Practice address

53 E Lake Mead Pkwy
Henderson, NV 89015-5832

Phone

(702) 566-4133

NPI assigned

Aug 23, 2023

Last updated

Nov 26, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shane L Ellswoth, DMD

Title

Managing Member

Phone

(503) 476-5242

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shane L Ellsworth, DMD

  • General Practice Dentistry
  • McMinnville, OR
  • NPI 1639379522
  NPD
• Jeffrey Stokes, DDS

  • General Practice Dentistry
  • Henderson, NV
  • NPI 1215053020
  NPD (past)

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

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700956800000",
    "number": "1992589444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 W CHARLESTON BLVD STE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461256",
            "telephone_number": "503-476-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 E LAKE MEAD PKWY",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890155832",
            "telephone_number": "702-566-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLSWORTH DENTAL LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-11-26",
        "certification_date": "2023-11-26",
        "status": "A",
        "authorized_official_last_name": "ELLSWOTH",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING  MEMBER",
        "authorized_official_telephone_number": "503-476-5242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Ellis, LMT
• Sean Ellis
• Ellsworth Cox NV Specialty Dental Services, PLLC
• Ellsworth Cox NV Specialty Dental Services, PLLC (Anthem Pediatric Dentistry)
• Ellsworth Cox Pediatric Dentistry LLC (Anthem Pediatric Dentistry)
• Chad W. Ellsworth, D.M.D.,M.S.
• Evan Bale Ellsworth, DMD
• Robert Dean Ellsworth
• Geraldine Elmore
• Joanie Luyn Elsten, RN

• General Practice Dentistry in Henderson, NV
• Providers in Henderson, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2023; 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.