Provider Demographics
NPI:1447369350
Name:ELLINGSEN ENDODONTICS PLLC
Entity type:Organization
Organization Name:ELLINGSEN ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLINGSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:509-921-5666
Mailing Address - Street 1:1005 N EVERGREEN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1485
Mailing Address - Country:US
Mailing Address - Phone:509-921-5666
Mailing Address - Fax:509-927-4842
Practice Address - Street 1:1005 N EVERGREEN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1485
Practice Address - Country:US
Practice Address - Phone:509-921-5666
Practice Address - Fax:509-927-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000099021223E0200X
WADE000064641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty