Provider Demographics
NPI:1477947976
Name:JAMES D. ELLIS DDS LLC
Entity Type:Organization
Organization Name:JAMES D. ELLIS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-333-3343
Mailing Address - Street 1:12100 W CENTER RD
Mailing Address - Street 2:STE 521
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3969
Mailing Address - Country:US
Mailing Address - Phone:402-333-3343
Mailing Address - Fax:402-333-3344
Practice Address - Street 1:12100 W CENTER RD
Practice Address - Street 2:STE 521
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3969
Practice Address - Country:US
Practice Address - Phone:402-333-3343
Practice Address - Fax:402-333-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6920261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental