Active NPI
Ali Etessam, D.D.S
- General Practice Dentistry
- Naples, FL
National Provider Identifier
1053620609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN14988
- Practice address
- 1575 Pine Ridge Rd
Suite 18
Naples, FL 34109-2107 - Phone
- (239) 566-1940
- NPI assigned
- Sep 30, 2010
- Sex
- Male
- 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 | DN14988 | FL | Primary |
Addresses
Primary practice location
1575 Pine Ridge Rd
Suite 18
Naples, FL 34109-2107
Mailing address
1575 Pine Ridge Rd.
Suite 18
Naples, FL 34109
Phone (239) 566-1940
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427279827 | Other | FL | CORPORTION NPI IS 1427279827 |
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 |
|---|---|---|---|
| DN14988 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285804800000",
"number": "1053620609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1575 PINE RIDGE RD.",
"address_2": "SUITE 18",
"city": "NAPLES",
"state": "FL",
"postal_code": "34109",
"telephone_number": "239-566-1940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 PINE RIDGE RD",
"address_2": "SUITE 18",
"city": "NAPLES",
"state": "FL",
"postal_code": "341092107",
"telephone_number": "239-566-1940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETESSAM",
"first_name": "ALI",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-30",
"last_updated": "2010-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN14988",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPORTION NPI IS 1427279827",
"identifier": "1427279827",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Naples, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.