Active NPI 1891835310 Individual Practitioner Male Practitioner

Fred E Ellis , DPD DENTURIST OF PRO

Denturist • Olympia, WA

Professional Overview & Biography Verified Profile Summary

Fred Ellis, DPD DENTURIST OF PRO is a registered healthcare professional specializing in Denturist in Olympia, WA. Practice services are available at 1822 BLACK LAKE BLVD SW under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1822 Black Lake Blvd Sw
Suite 101

Olympia, WA 98512

Telephone 3607099909

Fax 3607099915

Associated Practice Facility / Clinic

🏢 Edward I Dagher Md Pllc Facility NPI 1144659947

Specialty Benchmarks & Practice Insights

Comparative analytics for Denturist in Olympia, WA

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 10.2 Yrs

Regional Practice Density

6 Specialists

Practicing in Olympia, WA (204 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Denturist Primary Specialty

NUCC Taxonomy Code: 122400000X

State License WA DN00000358

A denturist is a licensed professional that serves patients with removable dental prosthetic oral health needs. A licensed denturist is trained in removable dental prosthetics and the fabrication of such devices.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

5046370 (WA)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners

Heidi Ellis , RDH

Dental Hygienist

NPI 1285853788

Registered Dental Hygienist

Dr. Wisam Al-Rawi , DDS

Dentist

NPI 1871888123

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 1822 BLACK LAKE BLVD SW, SUITE 101, OLYMPIA, WA 98512 (Tel: 3607099909)

📍

Updated Business Mailing Address July 08, 2007

Registered at 1822 BLACK LAKE BLVD SW, SUITE 101, OLYMPIA, WA 98512 (Tel: 3607099909)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as FRED ELLIS, DPD DENTURIST OF PRO

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Denturist (License #DN00000358 in WA)

🟢

Initial NPI Registration & Enumeration February 07, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1891835310

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: February 07, 2007

Last Update: July 08, 2007

Sole Proprietor: No

Update or Correct Profile

Mailing Address

1822 Black Lake Blvd Sw, Suite 101

Olympia, WA 98512

Phone: 3607099909

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.