Individual provider Active NPI

Yvonne Tijerina-Burleson, DDS

  • General Practice Dentistry
  • Anchorage, AK
National Provider Identifier
1750579512
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1394 Issued in AK
Practice address
4000 Ambassador Dr
Anchorage, AK 99508-5909
Phone
(907) 563-2662
NPI assigned
Oct 5, 2007
Last updated
Oct 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 23263 TX
General Practice Dentistry 1223G0001X 23263 TX
General Practice Dentistry 1223G0001X 1394 AK Primary

Addresses

Primary practice location

4000 Ambassador Dr
Anchorage, AK 99508-5909

Mailing address

4000 Ambassador Dr
Anchorage, AK 99508-5909

Other identifiers 1

IdentifierTypeStateIssuer
185728601MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160219000749 TX Order and Referring Only - DentistPractitioner - Dentist 9133424765

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1394AKMDGeneral Practice Dentistry
23263TXMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1750579512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 AMBASSADOR DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 AMBASSADOR DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085909",
            "telephone_number": "907-563-2662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIJERINA-BURLESON",
        "first_name": "YVONNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "23263",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "23263",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "1394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185728601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.