DR. CORBET KEVIN ELLISON (NPI# 1699730895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699730895 |
| Entity Type | Individual |
| Full Name | DR. CORBET KEVIN ELLISON |
| Credential | DDS |
| Practice Address |
11233 Shadow Creek Pkwy Ste 120 Pearland TX 77584-7345 |
| Mailing Address |
1304 Dart St Apt A Houston TX 77007-6243 |
| Practice Telephone | 2817415247 |
| Practice Fax Number | 2817415354 |
| Mailing Telephone | 2817250103 |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2011-10-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
23589 | TX | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DEN1000288 | DC | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 188083306 | 05 |
| Street Address |
11233 SHADOW CREEK PKWY STE 120 |
| City | PEARLAND |
| State | TX |
| Zip Code | 77584-7345 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770181281 | Joyce Ann Fugit | Technician | 8024 Serenity Dr., Pearland, TX 77584 | 2020-10-16 |
| 1558916403 | Houston Mint Dentistry, Pllc | Dentist | 12568 Broadway St Ste 140, Pearland, TX 77584 | 2019-08-07 |
| 1982259198 | Pearland Unicare Pharmacy LLC | Pharmacy | 10970 Shadow Creek Parkway Suite 110.2, Pearland, TX 77584 | 2019-08-05 |
| 1972155869 | Parastoo Natasha Coselli | Dentist | 2811 Buisness Dr Unit 105, Pearland, TX 77584 | 2019-07-11 |
| 1679042030 | Dorothy B Smith-hubbard | Counselor | 919 Norfolk Dr., Pearland, TX 77584 | 2018-11-15 |
| 1720562499 | Kelly Jean Barba | Physical Therapy Assistant | 3406 Businesses Center Dr, Pearland, TX 77584 | 2018-09-19 |
| 1437631884 | Laura Gillet | Registered Nurse | 3306 Summerwood Lane, Pearland, TX 77584 | 2018-09-02 |
| 1881176204 | Sharry Magne Rivera Estrella | Registered Nurse | 11900 Shadow Creek Parkway Apt 1311, Pearland, TX 77584 | 2018-09-01 |
| 1962982264 | Shara Elizabeth Watts | Occupational Therapist | 12001 Shadow Creek Pwky, Pearland, TX 77584 | 2018-08-16 |
| 1457830861 | Melvin Thomas | Dentist | 3215 Souther Green Drive, Pearland, TX 77584 | 2018-08-08 |
| Find all providers in zip 77584 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174866578 | Ellen Huang | Dentist | 2325 Echo Harbor Dr, Pearland, TX 77584-1570 | 2013-04-03 |
| 1699914705 | Abc123 Pediatric Dentistry, Pa | Dentist | 1901 Kirby St Ste 103, Pearland, TX 77584-5705 | 2009-02-12 |
| 1750591988 | Rhea Elyce Radford | Dentist | 10223 Broadway St Ste D1, Pearland, TX 77584-7881 | 2007-05-23 |
| 1659374221 | Pamela Clark | Dentist | 2360 County Road 94, Ste 102, Pearland, TX 77584-4884 | 2005-05-27 |
| 1114226271 | Radford Pediatric and Family Dentistry | Dentist | 10223 Broadway St, D-1, Pearland, TX 77584-7880 | 2011-03-15 |
| 1902037609 | Cecilia Elizabeth Carpio | Dentist | 11041 Shadow Creek Pkwy, Suite # 125, Pearland, TX 77584-7402 | 2009-07-30 |
| 1134384217 | Lisa Richardson Dds PC | Dentist | 2015 Broadway St, Suite B, Pearland, TX 77581-5698 | 2008-07-28 |
| 1992969570 | Lisa G. Richardson | Dentist | 2015 Broadway St, Suite B, Pearland, TX 77581-5698 | 2008-07-14 |
| 1871643312 | Ivette Diaz | Dentist | 1901 Kirby St, Suite 103, Pearland, TX 77584-5704 | 2007-01-10 |
| 1285710459 | Freddy R Cessac | Dentist | 2015 Broadway St, Ste B, Pearland, TX 77581-5501 | 2006-10-31 |
| Find all providers in PEARLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.