Individual provider Active NPI

Ellen M Zwick, D.D.S.

  • General Practice Dentistry
  • Bellefontaine, OH
National Provider Identifier
1619139177
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30-022776 Issued in OH
Practice address
1021 N Main St
Bellefontaine, OH 43311-2359
Phone
(937) 292-7828
Fax
(937) 292-7916
NPI assigned
Jun 26, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30-022776 OH Primary

Addresses

Primary practice location

1021 N Main St
Bellefontaine, OH 43311-2359

Mailing address

1021 N Main St
Bellefontaine, OH 43311-2359
Phone (937) 292-7828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161101002248 OH Order and Referring Only - General PracticePractitioner - General Practice 6709164338

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30-022776OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Logan Dental Care LLC General Practice Past Accepting new patients
Limazwick - Bellefontaine, LLC PastSince Dec 9, 2019 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476230400000",
    "number": "1619139177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 N MAIN ST",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433112359",
            "telephone_number": "937-292-7828",
            "fax_number": "937-292-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 N MAIN ST",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433112359",
            "telephone_number": "937-292-7828",
            "fax_number": "937-292-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZWICK",
        "first_name": "ELLEN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-26",
        "last_updated": "2016-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-022776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellefontaine, OH

Sources for this page

Verify at the official NPI Registry.