TY ELLSWORTH DMD
NPI 1699124123
Dentist in Show Low, AZ

Active since June 06, 2016PECOS Enrolled
2650 E SHOW LOW LAKE RD STE 1, SHOW LOW, AZ 85901(928) 537-4300(928) 532-6901 Get Directions Write a Review

NPPES record last updated: April 21, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Apr 21, 2026, Jun 28, 2021 (2 updates tracked since 2021).

About Ty Ellsworth Dmd NPPES

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

TY ELLSWORTH DMD (NPI 1699124123) is an individual dentist in Show Low, Arizona, licensed in Arizona (D009461) and active in the NPI registry since June 2016. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1699124123
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameTY ELLSWORTHCredential: DMD
Location Address2650 E SHOW LOW LAKE RD STE 1Show Low, AZ 85901-7955
Mailing AddressPo Box 1231Tucson, AZ 85702-1231 · (520) 670-3909 · Fax (520) 309-2560
Fax(928) 532-6901
Sole ProprietorNo
Enumeration DateJune 6, 2016
Last NPPES UpdateApril 21, 20262 updates tracked since enumeration
NPPES CertifiedApril 21, 2026
NPI 1699124123 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License Licensed in AZ · D009461
Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

2650 E SHOW LOW LAKE RD STE 1, Show Low, AZ 85901

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Ty Ellsworth Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85901 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Family)
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Nurse Practitioner
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Marriage & Family Therapist
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Nurse Practitioner (Family)
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Nurse Practitioner
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Dental Hygienist
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901
Counselor (Professional)
2650 E SHOW LOW LAKE RD STE 1
SHOW LOW, AZ 85901

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1699124123, enumerated as an "individual" on June 06, 2016.

The provider is located at 2650 E SHOW LOW LAKE RD STE 1 SHOW LOW, AZ 85901 and the phone number is (928) 537-4300.

Dentist with taxonomy code 122300000X.

The provider might be accepting Accepts: Ambetter from Arizona Complete Health, Anthem Blue. Please consult your insurance carrier or call the provider to verify.