Active NPI
Ivonne Ganem, DMD
- General Practice Dentistry
- Philadelphia, PA
National Provider Identifier
1689900045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS037703
- Practice address
- 200 Walnut St.
Philadelphia, PA 19106-3904 - Phone
- (215) 923-2233
- Fax
- (888) 608-7353
- NPI assigned
- Oct 20, 2009
- 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 | DS037703 | PA | Primary |
Addresses
Primary practice location
200 Walnut St.
Philadelphia, PA 19106-3904
Mailing address
200 Walnut St
Philadelphia, PA 19106-3904
Phone (215) 923-2233
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 |
|---|---|---|---|
| DS037703 | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Liberty Dental, LLC | 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": "1255996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255996800000",
"number": "1689900045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 WALNUT ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191063904",
"telephone_number": "215-923-2233",
"fax_number": "888-608-7353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WALNUT ST.",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191063904",
"telephone_number": "215-923-2233",
"fax_number": "888-608-7353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANEM",
"first_name": "IVONNE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-20",
"last_updated": "2009-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS037703",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.