Individual provider Active NPI

Derek Martin Lichter, D.D.S.

  • General Practice Dentistry
  • Chula Vista, CA
National Provider Identifier
1073643847
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
37983 Issued in CA
Practice address
247 F St
Chula Vista, CA 91910-2801
Phone
(619) 422-5317
Fax
(619) 422-2145
NPI assigned
Mar 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 37983 CA Primary

Addresses

Primary practice location

247 F St
Chula Vista, CA 91910-2801

Mailing address

247 F St
Chula Vista, CA 91910-2801
Phone (619) 422-5317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20150830000005 CA Order and Referring Only - DentistPractitioner - Dentist 3971819400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073643847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 F ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102801",
            "telephone_number": "619-422-5317",
            "fax_number": "619-422-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 F ST",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102801",
            "telephone_number": "619-422-5317",
            "fax_number": "619-422-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICHTER",
        "first_name": "DEREK",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "37983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.