Sergey Dedov, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DS039639 Issued in PA

Practice address

643 Colebrook Rd
Philadelphia, PA 19115-2808

Phone

(267) 632-1852

NPI assigned

Jul 15, 2013

Last updated

Jul 15, 2013By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tranquility Dental Care PLLC

  • Dental Clinic/Center
  • Yardley, PA
  • NPI 1255950382
  Authorized official Same address or phone

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1043651334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 COLEBROOK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152808",
            "telephone_number": "267-632-1852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 COLEBROOK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152808",
            "telephone_number": "267-632-1852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDOV",
        "first_name": "SERGEY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-15",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dedicated Pennsylvania Holding, LLC
• Dedicated Tender Care LLC
• Dedicating Time-You Matter
• Aleksander Dedo
• Elise Dedominicis, DDS
• Erica Paige Dedufour, LCSW
• Melanie Dee, DMD
• Diane M. Deely, M.D.
• Hagit Deemer, CRNP
• Talon Deemer

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; 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.