Elizabeth Ninan
Individual provider Active NPI General Practice Dentistry · Warrenville, IL
NPI 1942722012 · NPPES record last updated Sep 28, 2022
Key facts
- NPI
- 1942722012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019031232 (IL)
- Practice address
- 29W150 Butterfield Rd Ste 101
Warrenville, IL 60555-2805 - Phone
- (630) 965-1850
- NPI assigned
- Jul 11, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180926002331 | IL | Order and Referring Only - Dentist |
7315298536 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.031232 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elizabeth Ninan DDS PC | General Practice | Current |
Accepting new patients |
Locations
29W150 Butterfield Rd
Ste 101
Warrenville, IL 60555
Phone (630) 965-1850
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.031232 | IL | |
| General Practice Dentistry | 1223G0001X | 019031232 | IL | Yes |
Addresses
Primary practice location
29W150 Butterfield Rd Ste 101
Warrenville, IL 60555-2805
Mailing address
29W150 Butterfield Rd Ste 101
Warrenville, IL 60555-2805
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All providers in Warrenville, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.