Edly Destine, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

057473 Issued in NY

Practice address

88 W Lincoln Ave Ste 102
Mount Vernon, NY 10550-1181

Phone

(146) 996-9889

NPI assigned

Feb 11, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1360540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541721600000",
    "number": "1326387341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 W LINCOLN AVE STE 102",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105501181",
            "telephone_number": "914-699-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 W LINCOLN AVE STE 102",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105501181",
            "telephone_number": "146-996-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTINE",
        "first_name": "EDLY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-11",
        "last_updated": "2018-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "057473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04140667",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annie Louise Derrico
• Jyotsna Gupte Deshmukh, MD
• Candace Desiena, LCSW
• Mia Nichole Dessesaure
• Jessie Billings Destefano, OTRL
• Rita Nancy Deutsch, LCSW
• Rouchelle Deux, MSED, CCC-SLP
• Leroi Ephraim Dewitt Jr., RN
• Dhansukh Patel M.D. PC
• Diana'S Angels Home Care, Inc

• General Practice Dentistry in Mount Vernon, NY
• Providers in Mount Vernon, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2018; 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.