Ellen Agnes O'Brien, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DS029991L Issued in PA

Practice address

531 W Germantown Pike
Suite 104
Plymouth Meeting, PA 19462-1325

Phone

(610) 828-4100

NPI assigned

Oct 12, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Plymouth Meeting Family Dental

  • Dentist
  • Plymouth Meeting, PA
  • NPI 1457405250
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114016649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 FREDERICK RD",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190831013",
            "telephone_number": "610-449-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 W GERMANTOWN PIKE",
            "address_2": "SUITE 104",
            "city": "PLYMOUTH MEETING",
            "state": "PA",
            "postal_code": "194621325",
            "telephone_number": "610-828-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "ELLEN",
        "middle_name": "AGNES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS029991L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent Nwuzor, LPN
• Christene N Nyaboke, CRNP
• Mary Nyachieo, CNA
• F Nyema Sr.
• Jennifer Kirstin Nymark, CRNP
• Lori Ellen O'Brien, M.A.CCC-SLP
• Masumi O'Brien, PTA
• Lori E O'Connell, RN
• Valerie O'Connell
• Patricia O'Dell, LPN

• Dentist in Plymouth Meeting, PA
• Providers in Plymouth Meeting, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.