Healthcare Provider Details

I. General information

NPI: 1487146494
Provider Name (Legal Business Name): JARED SCOTT ELLINGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MARSHALL ST
COLDWATER MI
49036-1629
US

IV. Provider business mailing address

87 MARSHALL ST
COLDWATER MI
49036-1629
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-8289
  • Fax: 419-463-9024
Mailing address:
  • Phone: 517-278-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025377
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901600815
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: