Dr. Evan Bale Ellsworth, DMD

Dentist in Henderson, NV. Individual provider (NPI-1).

NPI number1003314535

StatusActive

Last updated in NPPESMar 17, 2019

Details

NPI: 1003314535
Entity type: Individual (NPI-1)
Name: Dr. Evan Bale Ellsworth
Credential: DMD
Sex: Male
Sole proprietor: Yes
Enumeration date: Jan 30, 2018
Last updated: Mar 17, 2019

Medicare and OIG

Medicare enrolled (PECOS): Yes · ORDER AND REFERRING ONLY - DENTIST
Can order and refer: Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
OIG exclusion list: This NPI is not listed

CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
122300000X	Dentist	7010	NV	Yes

Practice location

2660 Windmill Pkwy
Henderson, NV 89074-3385

Phone 702-990-2960

Mailing address

6127 S Rainbow Blvd Ste 100
Las Vegas, NV 89118-3256

Phone 702-793-2182

Other practice locations

6127 S Rainbow Blvd Ste 100
Las Vegas, NV 89118-3256

Phone 702-793-2182

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Other Dentist providers in Henderson, NV

All 124 Dentist providers in Henderson · All 9,892 providers in Henderson

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