Justin Israelsen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8200 Issued in AZ

Practice address

1900 Paseo San Luis
Sierra Vista, AZ 85635-4614

Phone

(520) 458-2415

Fax

(520) 458-0414

NPI assigned

May 9, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Pueblo del Sol Dental Care LLC

  • General Practice Dentistry
  • Sierra Vista, AZ
  • NPI 1831613934
  NPD (past) Authorized official
• Russell K. Hanes DDS, PC

  • Dental Clinic/Center
  • Sierra Vista, AZ
  • NPI 1730393174
  NPD (past)

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

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502150400000",
    "number": "1619236742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 PASEO SAN LUIS",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "85635",
            "telephone_number": "520-458-2415",
            "fax_number": "520-458-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 PASEO SAN LUIS",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856354614",
            "telephone_number": "520-458-2415",
            "fax_number": "520-458-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISRAELSEN",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-09",
        "last_updated": "2017-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "8200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Healing and Counseling, LLC
• Intercept Speech and Language, LLC
• Nusrum Iqbal, MD
• Renee Ann Irlmeier
• Tahera Islam, RD
• Andrea Jackson, FNP-BC
• Janell Ann Jackson, R.N.
• Joan Lynne Jackson, OTR/L
• Marissa Jackson
• Paul Charles Jackson, PTA

• General Practice Dentistry in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2017; 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.