1154545747 NPI number — DR. BITA ASHLEY ELLIS D.D.S.

Table of content: DR. BITA ASHLEY ELLIS D.D.S. (NPI 1154545747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154545747 NPI number — DR. BITA ASHLEY ELLIS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIS
Provider First Name:
BITA
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154545747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUNSHINE DENTISTS
Provider Second Line Business Mailing Address:
6035 BURBLE CENTRE PKWY SUITE #260
Provider Business Mailing Address City Name:
BURKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-978-1446
Provider Business Mailing Address Fax Number:
703-715-9229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUNSHINE DENTISTS
Provider Second Line Business Practice Location Address:
6035 BURBLE CENTRE PKWY SUITE #260
Provider Business Practice Location Address City Name:
BURKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-978-1446
Provider Business Practice Location Address Fax Number:
703-715-9229
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401-411106 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0401-411106 . This is a "VA. DENTAL LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com