Active NPI
Raven Elaine Yayah, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- O Fallon, IL
National Provider Identifier
1174288153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 019.034684
- Practice address
- 4905 Stone Falls Ctr Unit a
O Fallon, IL 62269-7802 - Phone
- (618) 622-3377
- NPI assigned
- Nov 3, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2021044569 | MO | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 019.034684 | IL | Primary |
Addresses
Primary practice location
4905 Stone Falls Ctr Unit a
O Fallon, IL 62269-7802
Mailing address
4201 W Pine Blvd Apt 103
Saint Louis, MO 63108-3078
Phone (901) 849-9389
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 |
|---|---|---|---|
| 2021044569 | MO | MD | Dentist |
| 019.034684 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1174288153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 W PINE BLVD APT 103",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631083078",
"telephone_number": "901-849-9389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4905 STONE FALLS CTR UNIT A",
"city": "O FALLON",
"state": "IL",
"postal_code": "622697802",
"telephone_number": "618-622-3377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YAYAH",
"first_name": "RAVEN",
"middle_name": "ELAINE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-03",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2021044569",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IL",
"license": "019.034684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.