# DR. ELLIS BURKE JARDINE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1922205715
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7240 | AZ | — |
| 1223P0700X | Prosthodontics | 27917 | TX | — |
| 1223P0700X | Prosthodontics | 9441 | TN | — |
| 1223P0700X | Prosthodontics | DE 60339865 | WA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DE60339865 | WA | Yes |

## Other

- **Enumeration date:** 06/27/2007
- **Last updated:** 03/07/2023