Charlene Diemandezi, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60609735 Issued in WA

Practice address

10011 Bridgeport Way SW Ste 700
Lakewood, WA 98499-2350

Phone

(253) 215-1101

NPI assigned

Nov 12, 2013

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

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 OR

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

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: cdiemandezi@direct.westerndental.com

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.

• Valley Dental Network

  dba Shields dental, Del Mar Dental, Nunez Yosemite Dental, Durfee Dental C

  • General Practice Dentistry
  • Madera, CA
  • NPI 1336493139
  NPD (past)

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1154751139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 W YOSEMITE AVE",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936374563",
            "telephone_number": "559-474-8200",
            "fax_number": "559-660-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10011 BRIDGEPORT WAY SW STE 700",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992350",
            "telephone_number": "253-215-1101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "708 W Yosemite Ave",
            "address_purpose": "LOCATION",
            "city": "Madera",
            "state": "CA",
            "postal_code": "936374563",
            "country_code": "US",
            "telephone_number": "559-474-8200",
            "fax_number": "559-660-5375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIEMANDEZI",
        "first_name": "CHARLENE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63077",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60609735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Rush LMP
• Rachel Ann Ibarrientos Diatta
• Sydney Dickinson, LMP
• Frank Dicostanzo, MSW
• Olivia Dieffenbach
• Logun Dienberg
• Christina Dietz
• Lisa Michele Digiacomo, RN
• Shelby Dilley
• Jessica Sue Rose Dillman, CO60579677

• General Practice Dentistry in Lakewood, WA
• Providers in Lakewood, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.