Individual provider Active NPI

Yanelis Perez, DMD

  • General Practice Dentistry
  • West Palm Beach, FL
National Provider Identifier
1790179364
Registry record updated Jun 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN21219 Issued in FL
Practice address
4047 Okeechobee Blvd
Suite 219
West Palm Beach, FL 33409-3239
Phone
(561) 640-7600
NPI assigned
Mar 22, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X DN21219 FL Primary

Addresses

Primary practice location

4047 Okeechobee Blvd
Suite 219
West Palm Beach, FL 33409-3239

Mailing address

4047 Okeechobee Blvd
Suite 219
West Palm Beach, FL 33409-3239
Phone (561) 640-7600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20160504002169 FL Order and Referring Only - DentistPractitioner - Dentist 2769781228

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN21219FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Codental Group LLC Current Accepting new patients
Blue Hearts Dental II General Practice Current Accepting new patients

Locations

4047 Okeechobee Blvd
Ste 219
West Palm Beach, FL 33409
Phone (561) 640-7600

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

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": "1426982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467072000000",
    "number": "1790179364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4047 OKEECHOBEE BLVD",
            "address_2": "SUITE 219",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334093239",
            "telephone_number": "561-640-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4047 OKEECHOBEE BLVD",
            "address_2": "SUITE 219",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334093239",
            "telephone_number": "561-640-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "YANELIS",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-22",
        "last_updated": "2016-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN21219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.