Active NPI
Melissa K Ewa, DDS
- General Practice Dentistry
- Evergreen Park, IL
National Provider Identifier
1386033496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.030096
- Practice address
- 9300 S Central Park Ave
Evergreen Park, IL 60805-1809 - Phone
- (773) 610-2549
- NPI assigned
- Jan 13, 2015
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.030096 | IL | Primary |
Addresses
Primary practice location
9300 S Central Park Ave
Evergreen Park, IL 60805-1809
Mailing address
9300 S Central Park Ave
Evergreen Park, IL 60805-1809
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 |
|---|---|---|---|
| 019.030096 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1386033496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9300 S CENTRAL PARK AVE",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "608051809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9300 S CENTRAL PARK AVE",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "608051809",
"telephone_number": "773-610-2549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWA",
"first_name": "MELISSA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-13",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.030096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evergreen Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.