Provider Demographics
NPI:1447570403
Name:ELLINGSON, WILLIAM J (DMD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:ELLINGSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E 11400 S SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6906
Mailing Address - Country:US
Mailing Address - Phone:801-255-2100
Mailing Address - Fax:801-619-8669
Practice Address - Street 1:1030 E 11400 S SUITE 2
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-6906
Practice Address - Country:US
Practice Address - Phone:801-255-2100
Practice Address - Fax:801-619-8669
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254091223G0001X
UT8414288-99221223G0001X
UT8414288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice