Ellenbecker, Jon Matthew

Ellenbecker, Jon Matthew is an individual health care provider with primary practice located at 5201 S Western Ave , Sioux Falls SD 57108-5004. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Ellenbecker, Jon Matthew can be contacted via phone (605) 339-2200.

Contact Information

Primary practice address
5201 S Western Ave Sioux Falls SD 57108-5004
Phone: (605) 339-2200
Fax: (605) 334-5530
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X M887 South Dakota

Profile Details

NPI number 1982792289
LBN Legal business name Ellenbecker, Jon Matthew
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982792289 NPPES
South Dakota MEDICAID 7803400

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