Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

ELLIS VILLAGE DENTAL GROUP, PROF. CORP.
NPI 1245145051
Dentist - General Practice in Tracy, CA

Q: What is Ellis Village Dental Group, Prof. Corp.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since August 17, 2026

2100 ELLIS TOWN DR STE 105, TRACY, CA 95377(209) 395-2393(209) 229-4303 Get Directions Write a Review

NPPES record added: August 17, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Ellis Village Dental Group, Prof. Corp. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELLIS VILLAGE DENTAL GROUP, PROF. CORP. (NPI 1245145051), doing business as Ellis Village Dental Group, is a healthcare organization registered as a general practice in Tracy, California and active in the NPI registry since August 2026. The organization lists Khaled Entabi, Owner, as its authorized official.

NPPES Registry Identity

NPI1245145051

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameELLIS VILLAGE DENTAL GROUP, PROF. CORP.

Location Address2100 ELLIS TOWN DR STE 105Tracy, CA 95377-9033

Mailing AddressPo Box 660041Dallas, TX 75266-0041 · (714) 845-8890 · Fax (303) 952-0892

Phone(209) 395-2393

Fax(209) 229-4303

Organization SubpartNo

Authorized OfficialKhaled EntabiOwner · (209) 395-2393

Enumeration DateAugust 17, 2026

NPPES CertifiedAugust 17, 2026

✔ NPI 1245145051 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

2100 ELLIS TOWN DR STE 105, Tracy, CA 95377

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Other Names 1

Doing Business AsEllis Village Dental Group

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ellis Village Dental Group, Prof. Corp.'s NPI number?

The NPI number for Ellis Village Dental Group, Prof. Corp. is 1245145051. It was assigned to this organization in the NPPES registry on August 17, 2026. The provider is doing business as Ellis Village Dental Group.

Where is Ellis Village Dental Group, Prof. Corp. located?

Ellis Village Dental Group, Prof. Corp. is located at 2100 Ellis Town Dr Ste 105, Tracy, CA 95377. The listed phone number is (209) 395-2393.

What is Ellis Village Dental Group, Prof. Corp.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Ellis Village Dental Group, Prof. Corp. was last updated on August 17, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.