Individual provider Active NPI

Yemesrach Chaka Demissie, DDS

  • Dentist
  • Nashville, TN
National Provider Identifier
1013783372
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0000012357 Issued in TN
Practice address
197 Thompson LN Ste E
Nashville, TN 37211-2415
Phone
(615) 837-4525
NPI assigned
Nov 28, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0000012357 TN Primary
Dentist 122300000X 61455535 WA

Addresses

Primary practice location

197 Thompson LN Ste E
Nashville, TN 37211-2415

Mailing address

2606 Fessey Park Rd Apt 311
Berry Hill, TN 37204-3168
Phone (206) 307-1414

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

LicenseStateTypeSpecialty
0000012357TNMDDentist
61455535WAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1701129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1013783372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2606 FESSEY PARK RD APT 311",
            "city": "BERRY HILL",
            "state": "TN",
            "postal_code": "372043168",
            "telephone_number": "206-307-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 THOMPSON LN STE E",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372112415",
            "telephone_number": "615-837-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMISSIE",
        "first_name": "YEMESRACH",
        "middle_name": "CHAKA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-28",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "0000012357",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "61455535",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.