Healthcare Provider Details

I. General information

NPI: 1174641971
Provider Name (Legal Business Name): CEMIL YESILSOY DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2810
  • Fax: 215-707-1482
Mailing address:
  • Phone: 215-707-2810
  • Fax: 215-707-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS025962L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS025962L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: