Active NPI
Jennifer Ebner, D.D.S.
- Dentist
- Phoenix, AZ
National Provider Identifier
1912063090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8003
- Practice address
- 4444 N 32ND St Ste 100
Phoenix, AZ 85018-3956 - Phone
- (602) 612-6120
- Fax
- (602) 612-6115
- NPI assigned
- Dec 31, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 46179 | CA | |
| Dentist | 122300000X | D08003 | AZ | |
| Dentist | 122300000X | 8003 | AZ | Primary |
Addresses
Primary practice location
4444 N 32ND St Ste 100
Phoenix, AZ 85018-3956
Mailing address
4444 N 32ND St Ste 100
Phoenix, AZ 85018-3956
Phone (602) 612-6120
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 |
|---|---|---|---|
| D08003 | AZ | MD | Dentist |
| 46179 | CA | MD | Dentist |
| 8003 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564617600000",
"number": "1912063090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4444 N 32ND ST STE 100",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850183956",
"telephone_number": "602-612-6120",
"fax_number": "602-612-6115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 N 32ND ST STE 100",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850183956",
"telephone_number": "602-612-6120",
"fax_number": "602-612-6115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBNER",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-31",
"last_updated": "2019-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "46179",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D08003",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "8003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.