Provider Demographics
NPI:1144962309
Name:BOONE, ELLYN ADKINS (DDS)
Entity type:Individual
Prefix:
First Name:ELLYN
Middle Name:ADKINS
Last Name:BOONE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELLYN
Other - Middle Name:CARTER
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF TENNESSEE 875 UNION AVE SUITE C211
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-6930
Mailing Address - Fax:
Practice Address - Street 1:8284 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3153
Practice Address - Country:US
Practice Address - Phone:513-231-1012
Practice Address - Fax:513-231-3925
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0270841223G0001X, 122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program