Active NPI
Nesreen Ibrahim, DMD
- Dentist
- Morris, IL
National Provider Identifier
1750128997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019036205
- Practice address
- 66 Green Acres Dr
Morris, IL 60450 - Phone
- (815) 318-2012
- NPI assigned
- Jul 15, 2024
- 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 | 019036205 | IL | Primary |
Addresses
Primary practice location
66 Green Acres Dr
Morris, IL 60450
Mailing address
305 S 40TH St Apt A1
Philadelphia, PA 19104-4149
Phone (215) 444-6006
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 |
|---|---|---|---|
| 019036205 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751328000000",
"number": "1750128997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 S 40TH ST APT A1",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044149",
"telephone_number": "215-444-6006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 GREEN ACRES DR",
"city": "MORRIS",
"state": "IL",
"postal_code": "60450",
"telephone_number": "815-318-2012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "NESREEN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-15",
"last_updated": "2025-07-01",
"certification_date": "2025-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019036205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morris, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.