Individual provider Active NPI

Elie Y Freilich, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Louis, MO
National Provider Identifier
1659751592
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2019042094 Issued in MO
Practice address
9911 Kennerly Rd Ste E
Saint Louis, MO 63128-2700
Phone
(917) 613-3769
NPI assigned
Jun 5, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 2019042094 MO Primary

Addresses

Primary practice location

9911 Kennerly Rd Ste E
Saint Louis, MO 63128-2700

Mailing address

9911 Kennerly Rd Ste E
Saint Louis, MO 63128-2700
Phone (917) 613-3769

Other practice location 1

1155 E Gannon Dr
Festus, MO 63028-2611
Phone (636) 931-4699

Other practice location 2

456 N New Ballas Rd Ste 249
Creve Coeur, MO 63141-6842
Phone (314) 569-2201

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

LicenseStateTypeSpecialty
2019042094MOMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
William a. Gray, D.M.D., LLC Oral and Maxillofacial Surgery CurrentSince Jan 17, 2021 Accepting new patients
Steven J. Hribernik, D.M.D., P.C. Oral and Maxillofacial Surgery Past Accepting new patients
Oral and Maxillofacial Surgeons Inc Oral and Maxillofacial Surgery Past Accepting new patients

Locations

1155 E Gannon Dr
Festus, MO 63028
Phone (636) 931-4699

456 N New Ballas Rd
Ste 249
Saint Louis, MO 63141
Phone (314) 569-2201

9911 Kennerly Rd
Ste E
Saint Louis, MO 63128
Phone (314) 842-4699

Interoperability endpoints

  • Direct secure messaging: elie.freilich.p1@direct.affiniahealthcare.nextgenshare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1659751592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9911 KENNERLY RD STE E",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282700",
            "telephone_number": "917-613-3769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9911 KENNERLY RD STE E",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282700",
            "telephone_number": "917-613-3769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1155 E Gannon Dr",
            "address_purpose": "LOCATION",
            "city": "Festus",
            "state": "MO",
            "postal_code": "630282611",
            "country_code": "US",
            "telephone_number": "636-931-4699",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "456 N New Ballas Rd Ste 249",
            "address_purpose": "LOCATION",
            "city": "Creve Coeur",
            "state": "MO",
            "postal_code": "631416842",
            "country_code": "US",
            "telephone_number": "314-569-2201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREILICH",
        "first_name": "ELIE",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2019042094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.