Provider Demographics
NPI:1871036426
Name:ELLSWORTHBECKHAM PLLC
Entity Type:Organization
Organization Name:ELLSWORTHBECKHAM PLLC
Other - Org Name:ONCALL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-863-7692
Mailing Address - Street 1:5940 W UNION HILLS DR
Mailing Address - Street 2:STE F110
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1308
Mailing Address - Country:US
Mailing Address - Phone:602-863-7692
Mailing Address - Fax:
Practice Address - Street 1:5940 W UNION HILLS DR
Practice Address - Street 2:STE F110
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1308
Practice Address - Country:US
Practice Address - Phone:602-863-7692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTHBECKHAM PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty