Provider Demographics
NPI:1851419451
Name:ELLIS, JESSICA ADAMS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ADAMS
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 SW WARM SPRINGS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9338
Mailing Address - Country:US
Mailing Address - Phone:503-692-0337
Mailing Address - Fax:
Practice Address - Street 1:8220 SW WARM SPRINGS ST
Practice Address - Street 2:SUITE 1114
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9338
Practice Address - Country:US
Practice Address - Phone:503-692-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8758122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist