Individual provider Active NPI

Philip Joseph Disalvo, D.D.S.

  • General Practice Dentistry
  • Metairie, LA
National Provider Identifier
1154425684
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2701 Issued in LA
Practice address
4741 Trenton St
Metairie, LA 70006-6517
Phone
(504) 455-2501
Fax
(504) 455-2564
NPI assigned
Sep 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2701 LA Primary

Addresses

Primary practice location

4741 Trenton St
Metairie, LA 70006-6517

Mailing address

4741 Trenton St
Metairie, LA 70006-6517
Phone (504) 455-2501

Other identifiers 1

IdentifierTypeStateIssuer
1827011MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150630000884 LA Order and Referring Only - DentistPractitioner - Dentist 9133431489

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2701LAMDElectroneurodiagnostic Specialist/Technologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154425684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4741 TRENTON ST",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700066517",
            "telephone_number": "504-455-2501",
            "fax_number": "504-455-2564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4741 TRENTON ST",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700066517",
            "telephone_number": "504-455-2501",
            "fax_number": "504-455-2564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISALVO",
        "first_name": "PHILIP",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "2701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1827011",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

Verify at the official NPI Registry.