DR. MAYLANI EVANGELISTA
NPI 1679612204
Dentist - Orthodontics and Dentofacial Orthopedics in Kenosha, WI

Active since February 06, 2007PECOS Enrolled
3410 80TH ST, KENOSHA, WI 53142(262) 697-0825(262) 697-0116 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Maylani Evangelista NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MAYLANI EVANGELISTA (NPI 1679612204) is an individual orthodontics and dentofacial orthopedics provider in Kenosha, Wisconsin, licensed in Wisconsin (5469) and active in the NPI registry since February 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1679612204
Entity TypeIndividualFemale
Primary Taxonomy1223X0400X
Provider Legal NameDR. MAYLANI EVANGELISTA
Location Address3410 80TH STKenosha, WI 53142-4975
Mailing Address3410 80th StKenosha, WI 53142-4975 · (262) 697-0825 · Fax (262) 697-0116
Fax(262) 697-0116
Sole ProprietorNo
Enumeration DateFebruary 6, 2007
Last NPPES UpdateJuly 8, 2007
NPI 1679612204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
License Licensed in WI · 5469
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
3410 80TH ST, Kenosha, WI 53142

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Maylani Evangelista is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53142 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dentist (General Practice)
3410 80TH ST
KENOSHA, WI 53142

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Maylani Evangelista's NPI number?

The NPI number for Maylani Evangelista is 1679612204. It was assigned to this individual provider in the NPPES registry on February 6, 2007.

Where is Maylani Evangelista located?

Maylani Evangelista practices at 3410 80th St, Kenosha, WI 53142. The listed phone number is (262) 697-0825.

What is Maylani Evangelista's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

Is Maylani Evangelista enrolled in Medicare?

Yes. Maylani Evangelista is registered in the Medicare PECOS enrollment system.

What insurance does Maylani Evangelista accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Companion Life Insurance Company and 5 other insurers list Maylani Evangelista as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Maylani Evangelista was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.