Derrick Adomian, DDS
Individual provider Active NPI Dentist · Santa Monica, CA
NPI 1336024868 · NPPES record last updated Aug 6, 2025
Key facts
- NPI
- 1336024868
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 111524 (CA)
- Practice address
- 919 Montana Ave
Santa Monica, CA 90403-1504 - Phone
- (818) 602-0712
- NPI assigned
- Aug 6, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111524 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 111524 | CA | Yes |
Addresses
Primary practice location
919 Montana Ave
Santa Monica, CA 90403-1504
Mailing address
919 Montana Ave
Santa Monica, CA 90403-1504
Phone (818) 602-0712
Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.