James F Deberry, DDS
Individual provider Active NPI Dentist · Warrensville HTS, OH
NPI 1215049705 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215049705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 30014353 (OH)
- Practice address
- 4480 Richmond Rd
Warrensville HTS, OH 44128 - Phone
- (216) 593-7600
- Fax
- (216) 593-7601
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160107003203 | OH | Order and Referring Only - Dentist |
5597067512 |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30014353 | OH | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30014353 | OH | Yes |
Addresses
Primary practice location
4480 Richmond Rd
Warrensville HTS, OH 44128
Mailing address
23751 S Woodland Rd
Shaker HTS, OH 44122
Phone (216) 283-0015
Other providers in Warrensville HTS, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.