Healthcare Provider Details

I. General information

NPI: 1841392172
Provider Name (Legal Business Name): CHAD W. ELLSWORTH D.M.D.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 ST. ROSE PKWY SUITE 100
HENDERSON NV
89052
US

IV. Provider business mailing address

1010 SWINGLINE DRIVE
HENDERSON NV
89015
US

V. Phone/Fax

Practice location:
  • Phone: 702-531-5437
  • Fax: 702-616-3565
Mailing address:
  • Phone: 702-564-7869
  • Fax: 702-616-3565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-39
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: