Spencer Allan Ellis
Individual provider Active NPI Dentist · Huntsville, TN
NPI 1992821763 · NPPES record last updated Feb 13, 2025
Key facts
- NPI
- 1992821763
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS0000007646 (TN)
- Practice address
- 170 Scott High Dr
Huntsville, TN 37756-4152 - Phone
- (423) 663-4444
- Fax
- (423) 663-4439
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| DS0000007646 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spencer a. Ellis | General Practice | Current |
Accepting new patients |
Locations
170 Scott High Dr
Huntsville, TN 37756
Phone (423) 663-4444
459 Industrial Ln
Oneida, TN 37841
Phone (423) 569-3456
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS0000007646 | TN | Yes |
Addresses
Primary practice location
170 Scott High Dr
Huntsville, TN 37756-4152
Mailing address
PO Box 209
Huntsville, TN 37756-0209
Phone (423) 663-4444
Other providers in Huntsville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2025. 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.