Healthcare Provider Details

I. General information

NPI: 1861358731
Provider Name (Legal Business Name): STEPHANIE ELLMAN DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 E GUADALUPE RD STE C107
TEMPE AZ
85283-3277
US

IV. Provider business mailing address

4510 E BANNER GATEWAY DR APT 2072
MESA AZ
85206-4755
US

V. Phone/Fax

Practice location:
  • Phone: 480-345-4017
  • Fax:
Mailing address:
  • Phone: 415-871-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD012703
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: