Active NPI
Edward S Yalisove, DMD
- General Practice Dentistry
- Wilmington, DE
National Provider Identifier
1518167014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- G10000900
- Practice address
- 1111 North Franklin Street
Wilmington, DE 19806-4327 - Phone
- (302) 658-4124
- Fax
- (302) 656-0927
- NPI assigned
- Jul 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | G10000900 | DE | Primary |
Addresses
Primary practice location
1111 North Franklin Street
Wilmington, DE 19806-4327
Mailing address
1111 North Franklin Street
Wilmington, DE 19806-4327
Phone (302) 658-4124
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 |
|---|---|---|---|
| G10000900 | DE | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185148800000",
"number": "1518167014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 NORTH FRANKLIN STREET",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198064327",
"telephone_number": "302-658-4124",
"fax_number": "302-656-0927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 NORTH FRANKLIN STREET",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198064327",
"telephone_number": "302-658-4124",
"fax_number": "302-656-0927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YALISOVE",
"first_name": "EDWARD",
"middle_name": "S",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-23",
"last_updated": "2007-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "DE",
"license": "G10000900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.