Active NPI
Emanuel Israel, DDS
- Dentist
- Port St Lucie, FL
National Provider Identifier
1295425007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 28721
- Practice address
- 308 NW Bethany Dr
Port St Lucie, FL 34986-3578 - Phone
- (772) 210-3982
- NPI assigned
- May 15, 2023
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 28721 | FL | Primary |
Addresses
Primary practice location
308 NW Bethany Dr
Port St Lucie, FL 34986-3578
Mailing address
11340 SW Lyra Dr
Port St Lucie, FL 34987-6420
Other practice location 1
466 SW Port St Lucie Blvd Ste 117
Port St Lucie, FL 34953-2091
Phone (722) 291-0149
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 |
|---|---|---|---|
| 28721 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724025600000",
"number": "1295425007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11340 SW LYRA DR",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349876420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 NW BETHANY DR",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349863578",
"telephone_number": "772-210-3982"
}
],
"practiceLocations": [
{
"address_1": "466 SW Port St Lucie Blvd Ste 117",
"address_purpose": "LOCATION",
"city": "Port St Lucie",
"state": "FL",
"postal_code": "349532091",
"country_code": "US",
"telephone_number": "722-291-0149",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ISRAEL",
"first_name": "EMANUEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-15",
"last_updated": "2024-08-19",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "28721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.