Tessa McDermott Dergan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7651 Issued in NE

Practice address

5311 S 138TH St
Omaha, NE 68137-2913

Phone

(402) 334-5656

NPI assigned

Jul 7, 2020

Sex

Female

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

Practice roles

Locations

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.

• Jared M. Homan D.D.S, P.C.

  • General Practice Dentistry
  • Omaha, NE
  • NPI 1255211694
  NPD
• Ralph M. Corpuz, DDS, PC

  • General Practice Dentistry
  • Omaha, NE
  • NPI 1447591755
  NPD (past)

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

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1134747157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9222 BURT ST APT 310",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681142431",
            "telephone_number": "402-320-1027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5311 S 138TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681372913",
            "telephone_number": "402-334-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERGAN",
        "first_name": "TESSA",
        "middle_name": "MCDERMOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "7651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renay L Derengowski
• Kennedy Dereus
• Yulia Dergal
• Andrew S Dergan, MD
• McKenna Kay Dergan
• Alexandra Rose Deriggi, DPT
• Lorrie Deriphonse
• Larry Derksen Jr.
• Dermatology Specialists of Omaha LLC
• Dermatology Surgery Center PC

• General Practice Dentistry in Omaha, NE
• Providers in Omaha, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.