DR. GARY LYNN ELLIS (NPI# 1700840717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700840717 |
| Entity Type | Individual |
| Full Name | DR. GARY LYNN ELLIS |
| Credential | DDS |
| Practice Address |
500 Chipeta Way Salt Lake City UT 84108-1221 |
| Practice Telephone | 8015832787 |
| Practice Fax Number | 8015845255 |
| Mailing Telephone | 8015832787 |
| Mailing Fax Number | 8015845255 |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
5129775-9921 | UT | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | DENTAL LICENSE | 5129775-9921 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497189203 | Gary D Ellis | Student in an Organized Health Care Education/Training Program | 4881 Sugar Maple Dr, 88mdg/mdos/sgow Wright Patterson Afb, Dayton, OH 45433-5529 | 2013-08-28 |
| Street Address |
500 CHIPETA WAY |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84108-1221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376548271 | Associated Regional and University Pathologists | Clinical Medical Laboratory | 500 Chipeta Way, Attn Accounts Receivable, Salt Lake City, UT 84108-1221 | 2005-06-16 |
| 1922233758 | Jonathan Robert Genzen | Pathology | 500 Chipeta Way, Mail Code: 115, Salt Lake City, UT 84108 | 2009-05-22 |
| 1689827826 | Pius Opendi Ochola | Student in an Organized Health Care Education/Training Program | 500 Chipeta Way, Arup Medical Directorship, Salt Lake City, UT 84108-1221 | 2008-10-31 |
| 1477712347 | Robert Schlaberg | Student in an Organized Health Care Education/Training Program | 500 Chipeta Way, Arup Laboratories, Salt Lake City, UT 84108-1221 | 2008-06-05 |
| 1255510285 | Kristi Johnson Smock | Pathology | 500 Chipeta Way, Mail Stop 115-g04, Salt Lake City, UT 84108 | 2007-10-26 |
| 1750577417 | Rodney Royce Miles | Pathology | 500 Chipeta Way, Arup Laboratories, Hemepath Medical Directors, Salt Lake City, UT 84108-1221 | 2007-09-17 |
| 1902003965 | Albert Kokang Ho | Pathology | 500 Chipeta Way, Arup-hematopathology Office, Salt Lake City, UT 84108-1221 | 2007-07-02 |
| 1326240631 | Todd William Kelley | Pathology | 500 Chipeta Way, Arup Laboratories, Medical Directors, Salt Lake City, UT 84108-1221 | 2007-05-31 |
| 1679647770 | Rong Mao | Pathology | 500 Chipeta Way, Salt Lake City, UT 84108-1221 | 2006-11-20 |
| 1689621948 | Julio Cesar Delgado | Medical Genetics | 500 Chipeta Way, Arup Laboratories, Salt Lake City, UT 84108-1221 | 2006-05-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548753056 | Maxine Ht Erickson | Assistant Behavior Analyst | 780 Guardsman Way, Salt Lake City, Ut 84108, Salt Lake City, USA 84108 | 2018-06-08 |
| 1841704061 | Robyn Carver | Occupational Therapist | 421 Wakara Wat, Salt Lake City, UT 84108 | 2017-11-27 |
| 1518478742 | Lcr Dental Sugar House | Dentist | 2068 S 2100 E Suite #a, Salt Lake City, UT 84108 | 2017-10-16 |
| 1447708912 | Aubrianne Squire Evans | Occupational Therapist | 421 S Wakara Way Ste 201, Salt Lake City, UT 84108 | 2016-09-14 |
| 1629524426 | Ryan Weisenbeck | Specialist/Technologist | 580 S Guardsman Way, Salt Lake City, UT 84108 | 2016-08-31 |
| 1164885547 | Michael Fazzone | Student in an Organized Health Care Education/Training Program | 530 South Wakara Way, University of Urah, School of Dentistry, Salt Lake City, UT 84108 | 2016-04-01 |
| 1669833489 | Bryon Claflin | Registered Nurse | 650 S Komas Ste 200, Salt Lake City, UT 84108 | 2016-03-08 |
| 1801283833 | Autism Assement Treatment Program Adult | Psychologist | 650 S Komas, Suite 200, Salt Lake City, UT 84108 | 2015-04-16 |
| 1578993275 | Matthew and David Dental Pllc | Dentist | 1355 Foothill Drive, Salt Lake City, UT 84108 | 2013-11-15 |
| 1841631520 | Deepika Garg | Internal Medicine | 675 S Arapeen Dr Ste 205, Salt Lake City, UT 84108 | 2013-07-10 |
| Find all providers in zip 84108 | ||||
| Taxonomy Code | 1223P0106X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Pathology |
| The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083973002 | Bryan Glen Trump | Dentist | 530 S Wakara Way, Salt Lake City, UT 84108-1213 | 2012-05-11 |
| 1053456368 | Crayton Ross Walker | Dentist | 1060 E 100 S, 204, Salt Lake City, UT 84102-1501 | 2007-02-21 |
| 1578663480 | University Pathology Associates | Dentist | 50 N Medical Dr, Pathology, Salt Lake City, UT 84132-0001 | 2006-09-22 |
| 1902905417 | Arup Pathology Associates | Dentist | 50 N Medical Dr, Pathology, Salt Lake City, UT 84132-0001 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518186188 | The Oral & Facial Surgery Center | Dentist | 938 S 2000 E, Suite 100, Clearfield, UT 84015-6282 | 2007-04-24 |
| 1205913035 | F. Zane Jessen | Dentist | 1508 E Skyline Dr Ste 800, Ogden, UT 84405-4889 | 2006-11-01 |
| 1194837625 | Kyle S Christensen | Dentist | 1268 W. South Jordan Parkway, Suite 200, South Jordan, UT 84095-4653 | 2006-08-31 |
| 1093713554 | Davis Center for Oral & Maxillofacial Surgery | Dentist | 890 W Heritage Park Blvd., Suite 103, Layton, UT 84041 | 2005-07-08 |
| 1548349251 | G. Shane Jessen | Dentist | 1508 E Skyline Dr Ste 800, Ogden, UT 84405-4889 | 2006-11-03 |
| City | SALT LAKE CITY |
| Zip Code | 84108 |
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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.