Yanisa Alexandra Stuart Salas

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN28355 Issued in FL

Practice address

3280 Mitchell Blvd
Moody AFB, GA 31699-1500

Phone

(229) 257-2778

NPI assigned

Mar 9, 2023

Last updated

Aug 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Hedera Counseling Center

  • Mental Health Counselor
  • Moody AFB, GA
  • NPI 1083296610
  NPD
• University of Florida

  • Dentist
  • Gainesville, FL
  • NPI 1053726778
  NPD (past)

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

{
    "created_epoch": "1678320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1316647100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3280 MITCHELL BLVD",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316991500",
            "telephone_number": "229-257-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 MITCHELL BLVD",
            "city": "MOODY AFB",
            "state": "GA",
            "postal_code": "316991500",
            "telephone_number": "229-257-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUART SALAS",
        "first_name": "YANISA",
        "middle_name": "ALEXANDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-09",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "37838587",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN28355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raquel Shelly Solivan Wilson, IDMT
• Katie Stauffer, ATC
• Collin M Stevens
• Sarah E Stone, APRN-CNP
• Corey J Strickland
• Stephen Michael Sutton, P.T.
• Claude Tolbert Jr.
• Jennifer Tomlinson
• Jancarlo Javier Torres-Martinez, IDMT, NRP, FP-C
• Ansley Kaye Ulmer, MD

• General Practice Dentistry in Moody AFB, GA
• Providers in Moody AFB, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.

Verify at the official NPI Registry.