Active NPI
Elfatih Eisa
- Dentist
- Edwardsville, IL
National Provider Identifier
1790511020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.035367
- Practice address
- 8 Sunset Hills Professional Ctr
Edwardsville, IL 62025-3760 - Phone
- (618) 831-8041
- Fax
- (618) 831-8042
- NPI assigned
- Sep 12, 2024
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019.035367 | IL | Primary |
Addresses
Primary practice location
8 Sunset Hills Professional Ctr
Edwardsville, IL 62025-3760
Mailing address
8 Sunset Hills Professional Ctr
Edwardsville, IL 62025-3760
Phone (202) 957-2324
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 |
|---|---|---|---|
| 019.035367 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726704000000",
"number": "1790511020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 SUNSET HILLS PROFESSIONAL CTR",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620253760",
"telephone_number": "202-957-2324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 SUNSET HILLS PROFESSIONAL CTR",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620253760",
"telephone_number": "618-831-8041",
"fax_number": "618-831-8042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EISA",
"first_name": "ELFATIH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-09-12",
"last_updated": "2024-09-19",
"certification_date": "2024-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.035367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edwardsville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.