Active NPI
Irina Victoria Ganzman, DMD
- Dentist
- Glenview, IL
National Provider Identifier
1215388608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.030742
- Practice address
- 2400 Ravine Way Ste 400
Glenview, IL 60025-7615 - Phone
- (847) 998-5100
- NPI assigned
- Jun 27, 2016
- Last updated
- Dec 12, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.030742 | IL | Primary |
Addresses
Primary practice location
2400 Ravine Way Ste 400
Glenview, IL 60025-7615
Mailing address
2400 Ravine Way Ste 400
Glenview, IL 60025-7615
Phone (847) 998-5100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.030742 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| William J Frericks, DDS, LTD | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702339200000",
"number": "1215388608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 RAVINE WAY STE 400",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600257615",
"telephone_number": "847-998-5100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 RAVINE WAY STE 400",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600257615",
"telephone_number": "847-998-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANZMAN",
"first_name": "IRINA",
"middle_name": "VICTORIA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-27",
"last_updated": "2023-12-12",
"certification_date": "2023-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.030742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.