Active NPI
Maria Ejsbrenner, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1891964524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 01921593
- Practice address
- 5505 N Menard Ave
Chicago, IL 60630-1221 - Phone
- (773) 631-7070
- Fax
- (773) 631-3770
- NPI assigned
- Feb 27, 2008
- 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 | 01921593 | IL | Primary |
Addresses
Primary practice location
5505 N Menard Ave
Chicago, IL 60630-1221
Mailing address
5505 N Menard Ave
Chicago, IL 60630-1221
Phone (773) 631-7070
Other names 1
- Maria Iwanicki
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 |
|---|---|---|---|
| 01921593 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1891964524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5505 N MENARD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606301221",
"telephone_number": "773-631-7070",
"fax_number": "773-631-3770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5505 N MENARD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606301221",
"telephone_number": "773-631-7070",
"fax_number": "773-631-3770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EJSBRENNER",
"first_name": "MARIA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-27",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "01921593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARIA",
"last_name": "IWANICKI",
"credential": "DDS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.