Yetunde Ibiyemi Patrick, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN1001234 Issued in DC

Practice address

1515 U St NW Ste a-1C1
Washington, DC 20009-3948

Phone

(202) 900-9006

Fax

(202) 900-8980

NPI assigned

Jan 20, 2012

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shaw Family Dentistry PLLC

  dba U Street Family Dentistry

  • Dentist
  • Washington DC, DC
  • NPI 1477052272
  NPD (past) Authorized official

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

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1225309362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 U STREET NW SUITE A1 C-1",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20009",
            "telephone_number": "202-900-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 U ST NW STE A-1C1",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200093948",
            "telephone_number": "202-900-9006",
            "fax_number": "202-900-8980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3114 Queens Chapel Rd",
            "address_purpose": "LOCATION",
            "city": "Hyattsville",
            "state": "MD",
            "postal_code": "207823665",
            "country_code": "US",
            "telephone_number": "301-338-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "YETUNDE",
        "middle_name": "IBIYEMI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "15003",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "DEN1001234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "052089600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Edward Patrick, MD
• Kathryn Patrick
• Lauren Marie Patrick, M.D.
• Sandra A Patrick, HHA
• Taimeisha Patrick
• Adilisha Patrom
• Patrons Healthcare Services
• Rajaram Pattar, MD
• Amy Boardman Patten, NP
• Crystal Patten

• Dentist in Washington, DC
• Providers in Washington, DC by specialty
• Dentist in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.