Provider Demographics
NPI:1699828533
Name:ELLIS, JAMES PADGETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PADGETT
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 BRADENTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7558
Mailing Address - Country:US
Mailing Address - Phone:614-764-9455
Mailing Address - Fax:614-526-3745
Practice Address - Street 1:5155 BRADENTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7558
Practice Address - Country:US
Practice Address - Phone:614-764-9455
Practice Address - Fax:614-526-3745
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0215351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery