David Rush Deitrick, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9419 Issued in MD

Practice address

815 Ritchie Hwy
Suite 202
Severna Park, MD 21146

Phone

(410) 647-3883

Fax

(410) 647-0504

NPI assigned

Oct 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013093343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 RITCHIE HWY",
            "address_2": "SUITE 202",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "21146",
            "telephone_number": "410-647-3883",
            "fax_number": "410-647-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 RITCHIE HWY",
            "address_2": "SUITE 202",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "21146",
            "telephone_number": "410-647-3883",
            "fax_number": "410-647-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITRICK",
        "first_name": "DAVID",
        "middle_name": "RUSH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "9419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2228",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "180400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Ryan Davis, LGPC
• Mollie M Davis, MD
• Paul Deasey, D.D.S.
• Mary C Deckelman, MD
• Rachel Elizabeth Dehart, MS OTR/L
• Reese L Delp
• Nina Marie Demaio
• Meagan Jennifer Desilva, LCSW
• Stephen Devlin, MD
• Sarah Hughes Dewling, DPT

• General Practice Dentistry in Severna Park, MD
• Providers in Severna Park, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.