# ELLSWORTH DENTAL LP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992589444
- **Authorized official:** DR. SHANE L ELLSWOTH DMD (MANAGING MEMBER)
- **Authorized official phone:** (503) 476-5242

## Contact information

- **Practice address:** 53 E LAKE MEAD PKWY, HENDERSON, NV 89015-5832
- **Practice address phone:** (702) 566-4133
- **Mailing address:** 5701 W CHARLESTON BLVD STE 103, LAS VEGAS, NV 89146-1256
- **Mailing address phone:** (503) 476-5242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/23/2023
- **Last updated:** 11/26/2023