DR. MATTHEW T ELLISON (NPI# 1790393213) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790393213 |
| Entity Type | Individual |
| Full Name | DR. MATTHEW T ELLISON |
| Credential | DDS |
| Practice Address |
Dental Clinic 2 3740 South 14th St. Joint Base Lewis-mcchord WA 98433 |
| Mailing Address |
2828 W Avenue O4 Palmdale CA 93551-3402 |
| Practice Telephone | 6619174077 |
| Mailing Telephone | 6619174077 |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | D11258 | OR | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487065918 | Matthew Patrick Ellison | Dentist | 150 West Crescent Square Dr., Graham, NC 27253 | 2014-05-19 |
| 1578185211 | Matthew S Ellison | Student in an Organized Health Care Education/Training Program | 5635 W Fort St, Detroit, MI 48209-3154 | 2020-05-16 |
| 1760689012 | Matthew Blair Ellison | General Practice | 1 Medical Center Drive, Morgantown, WV 26506 | 2007-06-29 |
| 1598865438 | Matthew D Ellison | Otolaryngology | 1781 Tate Blvd Se, Suite 201, Hickory, NC 28602-4251 | 2006-09-22 |
| Street Address |
DENTAL CLINIC 2 3740 SOUTH 14TH ST. |
| City | JOINT BASE LEWIS-MCCHORD |
| State | WA |
| Zip Code | 98433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134739881 | Bryonna Floyd | Dental Assistant | 11572 17th & C Street, Joint Base Lewis-mcchord, WA 98433 | 2020-08-07 |
| 1952933251 | Julie Kristen Dutler | Dental Hygienist | 11572 C St, Jblm, WA 98433 | 2020-02-05 |
| 1881224806 | James Eric Carvelli | Dental Assistant | 11572 17th Street & C Street, Joint Base Lewis Mcchord, WA 98433 | 2020-01-17 |
| 1245891019 | Tanya Latrell Lesane | Counselor | 9924b W. Johnson St, Joint Base Lewis0mcchord, WA 98433 | 2019-06-24 |
| 1740844224 | Allison Tracy Bertoni | Student in an Organized Health Care Education/Training Program | 3740 South 14th Street, Joint Base Lewis-mcchord, WA 98433 | 2019-04-30 |
| 1124682448 | Lori Ann Sage | Registered Nurse | Building 11582, 17th & C Street, Joint Base Lewis-mcchord, WA 98433 | 2019-04-23 |
| 1639645997 | Emily Elisabeth Armstrong | Emergency Medical Technician, Paramedic | 3370 Evergreen Ave, Jblm, WA 98433 | 2018-10-15 |
| 1982182101 | Won Kyung Yang | Dentist | 11582 C St., Jblm, WA 98433 | 2018-07-31 |
| 1205325966 | Gloria Judith Penate I | Dental Hygienist | 2103 North Division Street, Tacoma, WA 98433 | 2018-05-08 |
| 1801390489 | Michelle Budzynski | Spec/Tech, Health Info | 3740 14th and Railroad Ave., Jblm, WA 98433 | 2018-03-20 |
| Find all providers in zip 98433 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932727476 | Philippe Mansour | Dentist | 3740 South 14th St, Joint Base Lewis-mcchord, WA 98433 | 2020-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851991319 | Ashley Lynn Wildhaber | Dentist | 111 Tumwater Blvd Se # 301, Tumwater, WA 98501-6400 | 2020-10-26 |
| 1124627757 | Eric Kun Kim | Dentist | 7160 Burden Blvd Ste 102, Pasco, WA 99301-4469 | 2020-10-24 |
| 1174121966 | Brandon C Hahn | Dentist | 6574 153rd Ave Se, Bellevue, WA 98006-5424 | 2020-10-13 |
| 1144828237 | William Garcia | Dentist | 1214 Sw Scotton Way Ste 101, Battle Ground, WA 98604-2715 | 2020-10-12 |
| 1568069391 | Neha Agarwal | Dentist | 13605 Ne 10th Pl # 8-101, Bellevue, WA 98005-2743 | 2020-10-05 |
| 1134736028 | Ibraheem M Al Naqshabandy | Dentist | 4747 30th Ave Ne Apt K174, Seattle, WA 98105-4032 | 2020-09-25 |
| 1598371866 | Maryam Tabarestani | Dentist | 24325 7th Pl W, Bothell, WA 98021-8525 | 2020-09-21 |
| 1922614890 | Vicky Herrera | Dentist | 10720 5th Ave Ne Apt 605, Seattle, WA 98125-7258 | 2020-09-16 |
| 1407461825 | Jangsu Kiyoshi | Dentist | 3006 Mahogany St Ne, Lacey, WA 98516-5589 | 2020-09-11 |
| 1407461270 | Crisafulli Dental | Dentist | 18920 Bothell Way Ne Ste 200, Bothell, WA 98011-1981 | 2020-09-09 |
| Find all providers with the same taxonomy | ||||
| City | JOINT BASE LEWIS-MCCHORD |
| Zip Code | 98433 |
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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.