David Demissie, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS104225 Issued in CA

Practice address

1781 N Waterman Ave
San Bernardino, CA 92404-5114

Phone

(909) 882-4988

NPI assigned

May 18, 2018

Sex

Male

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

State licenses

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.

• Amy Berhanu Demissie DDS PC

  • Dentist
  • Banning, CA
  • NPI 1215009246
  NPD (past)

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

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1154812709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 N SAN GORGONIO AVE",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922205523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1781 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045114",
            "telephone_number": "909-882-4988"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "471 N San Gorgonio Ave",
            "address_purpose": "LOCATION",
            "city": "Banning",
            "state": "CA",
            "postal_code": "922205523",
            "country_code": "US",
            "telephone_number": "951-849-2888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMISSIE",
        "first_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-18",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS104225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Martin Deluca, D.C.
• Marissa Helen Delvalle, RN, BSN, PMHNP
• Dema Agency Consultants LLC
• Alexis Demery
• Helen Kathleen Demetrion, M.S.
• Marquita Shenea Dempsey, AMFT, ED,D.
• Jeffrey Lloyd Denison
• Denkorach Inc
• Brooke Ashley Dennis
• Lashanne D Dennis

• All providers in San Bernardino, CA
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; 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.