Jesse Ellsworth, DMD
Dentist in Oak Ridge, TN. Individual provider (NPI-1).
NPI number1043662778
StatusActive
Last updated in NPPESAug 30, 2022
Details
- NPI
- 1043662778
- Entity type
- Individual (NPI-1)
- Name
- Jesse Ellsworth
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 6, 2016
- Certification date
- Aug 30, 2022
- Last updated
- Aug 30, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- 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 | DS10287 | TN | Yes |
Practice location
126 E Division RdOak Ridge, TN 37830-6906
Phone 865-481-0008 · Fax 865-481-0695
Mailing address
1018 Garrison Ridge BlvdKnoxville, TN 37922-5155
Phone 801-598-2774
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 21 Dentist providers in Oak Ridge · All 1,139 providers in Oak Ridge
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