Provider Demographics
NPI:1265153712
Name:SMITH, JAMES ELLSWORTH (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ELLSWORTH
Last Name:SMITH
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 1:27000 W LUGONIA AVE APT 11216
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2095
Mailing Address - Country:US
Mailing Address - Phone:949-282-9142
Mailing Address - Fax:
Practice Address - Street 1:2878 CAMPUS PKWY STE 1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0945
Practice Address - Country:US
Practice Address - Phone:951-571-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1078291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice