MR. FRED E ELLIS (NPI# 1891835310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891835310 |
| Entity Type | Individual |
| Full Name | MR. FRED E ELLIS |
| Credential | DPD DENTURIST OF PRO |
| Practice Address |
1822 Black Lake Blvd Sw Suite 101 Olympia WA 98512 |
| Practice Telephone | 3607099909 |
| Practice Fax Number | 3607099915 |
| Mailing Telephone | 3607099909 |
| Mailing Fax Number | 3607099915 |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122400000X | Denturist | DN00000358 | WA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 5046370 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780604801 | Fred Ray Ellis Jr. | Dentist | 233 S. Pleasant Ave., #303, Somerset, PA 15501-2188 | 2006-07-20 |
| Street Address |
1822 BLACK LAKE BLVD SW SUITE 101 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98512 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487732145 | Edward I. Dagher | Physical Medicine & Rehabilitation | 1822 Black Lake Blvd Sw, Suite 102, Olympia, WA 98512-5628 | 2006-11-01 |
| 1144659947 | Edward I Dagher Md Pllc | Clinic/Center | 1822 Black Lake Blvd Sw, Suite 102, Olympia, WA 98512-5628 | 2013-11-02 |
| 1720242969 | Brenda Marie Corkum | Counselor | 1822 Black Lake Blvd Sw, Suite 102-d, Olympia, WA 98512-5628 | 2008-07-16 |
| 1710057666 | Dixie Rhodes Havlak | Dietitian, Registered | 1822 Black Lake Blvd Sw, Suite 102-c, Olympia, WA 98512-5628 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578161402 | Yavonnie Leslie Griggs | Peer Specialist | 3285 Ferguson Ln Sw, Tumwater, Wa 98512, Tumwater, WA 98512 | 2020-10-13 |
| 1205465622 | Falina Marie Luce | Counselor | 3285 Ferguson St, Olympia, WA 98512 | 2020-04-07 |
| 1881234912 | Andres Enrique Velazquez | Counselor | 3285 Ferguson St Sw Wa 98512, Tumwater, WA 98512 | 2020-01-07 |
| 1700432507 | Maria E Zavala Negrete | Behavior Technician | 3285 Ferguson Street Southwest, Tumwater, WA 98512 | 2019-08-16 |
| 1669026951 | Bradley Allen Labrador | Social Worker | 3285 Ferguson St, Sw, Tumwater, WA 98512 | 2019-07-25 |
| 1033762893 | Janice Lapreal Swanzey | Licensed Practical Nurse | 3285 Ferguson Lane St Sw, Olympia, WA 98512 | 2019-07-22 |
| 1821569195 | Linda Marie Moffitt | Registered Nurse | 7741 Littlerock Rd. Sw, Tumwater, WA 98512 | 2018-12-16 |
| 1427534577 | Matthew Hart | Occupational Therapist | 2620 Rw Johnson Boulevard Southwest Suite 112, Tumwater, WA 98512 | 2018-07-12 |
| 1558858019 | Amy Louise Cline | Counselor | 6005 Tyee Drive Sw, Tumwater, WA 98512 | 2018-04-19 |
| 1669998183 | Bradley Ross Bishop | Registered Nurse | 3285 Ferguson Street Sw, Tumwater, WA 98512 | 2017-08-16 |
| Find all providers in zip 98512 | ||||
| Taxonomy Code | 122400000X |
| Grouping | Dental Providers |
| Classification | Denturist |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740700145 | Joseph Brandon Kimmel | Denturist | 5032 Beverly Dr Ne, Olympia, WA 98516 | 2017-06-27 |
| 1093907222 | James M Elvin | Denturist | 1401 4th Ave E, Olympia, WA 98506-4484 | 2007-08-12 |
| 1851459069 | Lilly Denture Center, Inc | Denturist | 200 Lilly Rd Ne Ste A, Olympia, WA 98506-5080 | 2006-12-04 |
| 1700960978 | Julie Grace Stone | Denturist | 1700 Cooper Point Rd Sw Ste B3, Olympia, WA 98502-1110 | 2006-10-24 |
| 1740602176 | Patrick Carbone | Denturist | 200 Lilly Rd Ne Ste A, Olympia, WA 98506-5080 | 2014-01-21 |
| 1245359926 | Discovery Denture Center, Inc. | Denturist | 1700 Cooper Point Rd Sw Ste B3, Olympia, WA 98502-1110 | 2007-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427689421 | Tri-cities Denture Studio Pllc | Denturist | 3909 Creekside Loop Ste 110, Yakima, WA 98902-4880 | 2020-01-29 |
| 1447894811 | Michael Hu | Denturist | 430 N West Ave Ste 3, Arlington, WA 98223-1539 | 2019-10-29 |
| 1265999494 | Sagebrush Dental LLC | Denturist | 1114 N Mission St Ste C, Wenatchee, WA 98801-6711 | 2019-02-24 |
| 1295299113 | Stephanie Jean Hemenway | Denturist | 209 W Main Ave., Morton, WA 98356 | 2019-01-24 |
| 1538633664 | Trang Phung | Denturist | 1242 State Ave Ste G, Marysville, WA 98270-3672 | 2019-01-11 |
| 1053884338 | Juan Edward Berlanga | Denturist | 654 N Rochester St, Tacoma, WA 98406-1724 | 2019-01-09 |
| 1346713765 | Cody M Dunivin | Denturist | 129 Valley Meadows Dr, Chehalis, WA 98532-8652 | 2019-01-08 |
| 1841765682 | Andrew Payne | Denturist | 714 N Chelan Ave, Wenatchee, WA 98801-2069 | 2018-10-08 |
| 1154811982 | Jayson Allen Laney | Denturist | 4001 Colby Ave Ste 2, Everett, WA 98201-6208 | 2018-05-17 |
| 1932697117 | Jason Lee Alsbury | Denturist | 1715 W Kennewick Ave, Kennewick, WA 99336-3378 | 2018-04-24 |
| Find all providers with the same taxonomy | ||||
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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.