Healthcare Provider Details

I. General information

NPI: 1194654459
Provider Name (Legal Business Name): BROOKE ELIZABETH ELLIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 COLLEGE ST
WINFIELD KS
67156-2442
US

IV. Provider business mailing address

107 COLLEGE ST
WINFIELD KS
67156-2442
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-9580
  • Fax:
Mailing address:
  • Phone: 620-221-9580
  • Fax: 620-262-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8173
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: