Active NPI
Yetunde Fasoro, DDS
- Dentist
- Chippewa Falls, WI
National Provider Identifier
1932508496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1001171-15
- Practice address
- 850 Lakeland Dr
Chippewa Falls, WI 54729-1687 - Phone
- (715) 738-2000
- NPI assigned
- Aug 20, 2014
- Sex
- Female
- 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 | 1001171-15 | WI | Primary |
Addresses
Primary practice location
850 Lakeland Dr
Chippewa Falls, WI 54729-1687
Mailing address
PO Box 18298
Palatine, IL 60055-8298
Phone (888) 533-2684
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150803002666 | WI | Order and Referring Only - Oral Surgery | 1052625167 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN014857 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787270400000",
"number": "1932508496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18298",
"city": "PALATINE",
"state": "IL",
"postal_code": "600558298",
"telephone_number": "888-533-2684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 LAKELAND DR",
"city": "CHIPPEWA FALLS",
"state": "WI",
"postal_code": "547291687",
"telephone_number": "715-738-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FASORO",
"first_name": "YETUNDE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-20",
"last_updated": "2026-08-21",
"certification_date": "2026-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "1001171-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chippewa Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.