Scott S Derossi, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DS029512L Issued in PA

Practice address

1430 John Wesley Gilbert Drive, GC-1024
Ghsu College of Dental Medicine
Augusta, GA 30912-1001

Phone

(706) 721-9633

Fax

(706) 723-0266

NPI assigned

Jun 14, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Au Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Augusta, GA
  • NPI 1841733326
  NPD (past)
• University of Penn - Oral Surgery Associates

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Philadelphia, PA
  • NPI 1912011321
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1184667370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE, GC-1024",
            "address_2": "GHSU COLLEGE OF DENTAL MEDICINE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309121001",
            "telephone_number": "706-721-9633",
            "fax_number": "706-723-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE, GC-1024",
            "address_2": "GHSU COLLEGE OF DENTAL MEDICINE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309121001",
            "telephone_number": "706-721-9633",
            "fax_number": "706-723-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSSI",
        "first_name": "SCOTT",
        "middle_name": "S",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "PA",
            "license": "DS029512L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016969200001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Depuy
• Christina Elaine Deremer, PHARM.D., BCPS
• Ashton Deremigio, DPT
• Paul-Robert Derenoncourt, MD
• Dermatology and Skin Cancer Center of Augusta, P.C.
• Derrick E Kimble Inc
• Derrick E. Kimble Inc
• Jay Desai, M.D.
• Julinkumar J Desai, M.D,
• Ketki Desai, MD

• Oral & Maxillofacial Surgery (D.M.D.) in Augusta, GA
• Providers in Augusta, GA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; 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.