Derek Demianczyk, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS040025 Issued in PA

Practice address

357 S Gulph Rd Ste 110
King of Prussia, PA 19406-3174

Phone

(610) 337-2325

NPI assigned

May 1, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Practice roles

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

• Broomall Pediatric Dentistry & Orthodontics,P.C.

  • Pediatric Dentistry
  • Havertown, PA
  • NPI 1336202787

  General Practice

  NPD (past)

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1043655335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 S GULPH RD STE 110",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063174",
            "telephone_number": "610-337-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 S GULPH RD STE 110",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063174",
            "telephone_number": "610-337-2325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 N Charlotte St Ste 2N",
            "address_purpose": "LOCATION",
            "city": "Pottstown",
            "state": "PA",
            "postal_code": "194644645",
            "country_code": "US",
            "telephone_number": "484-300-4220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1220 W Chester Pike",
            "address_purpose": "LOCATION",
            "city": "Havertown",
            "state": "PA",
            "postal_code": "190833339",
            "country_code": "US",
            "telephone_number": "484-454-3230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMIANCZYK",
        "first_name": "DEREK",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-01",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS040025",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS040025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Delone
• Delphi Medical Group
• Angelo Deluca, PHARM.D.
• Robert Delucas Jr., CRNP
• Jaime Demers
• Ava Demirjian
• Devon Rae Denman
• Allyson Dennin
• Barbara Y Dennis
• Dental & Co. King of Prussia, PLLC (Crownline Dental)

• General Practice Dentistry in King of Prussia, PA
• Providers in King of Prussia, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; 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.