Active NPI
David Desta
- Endodontics
- Rockville, MD
National Provider Identifier
1144610916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 15705
- Practice address
- 9600 Blackwell Rd Ste 103
Rockville, MD 20850-3670 - Phone
- (178) 404-3236
- NPI assigned
- Jan 30, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 15705 | MD | Primary |
Addresses
Primary practice location
9600 Blackwell Rd Ste 103
Rockville, MD 20850-3670
Mailing address
9600 Blackwell Rd Ste 103
Rockville, MD 20850-3670
Phone (617) 840-4323
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
| License | State | Type | Specialty |
|---|---|---|---|
| 15705 | MD | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Endodontics LLC | Endodontics | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Endodontics
- Columbia, MD
- NPI 1629922190
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681171200000",
"number": "1144610916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9600 BLACKWELL RD STE 103",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208503670",
"telephone_number": "617-840-4323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9600 BLACKWELL RD STE 103",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208503670",
"telephone_number": "178-404-3236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTA",
"first_name": "DAVID",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-30",
"last_updated": "2023-04-11",
"certification_date": "2023-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist, Endodontics",
"state": "MD",
"license": "15705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.