Anissa Derrouche, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

20671 Issued in MA

Practice address

529 Main St Ste 209
Charlestown, MA 02129-1135

Phone

(617) 241-9220

Fax

(617) 241-4905

NPI assigned

May 16, 2007

Sex

Female

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

Enrolled in MA

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

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.

• Carol Yun PC

  • General Practice Dentistry
  • Cambridge, MA
  • NPI 1073680039
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1386851996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 MAIN ST STE 209",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021291135",
            "telephone_number": "617-241-9220",
            "fax_number": "617-241-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 MAIN ST STE 209",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021291135",
            "telephone_number": "617-241-9220",
            "fax_number": "617-241-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERROUCHE",
        "first_name": "ANISSA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "20671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina Darois, RN
• Amanda A. Datro, LICSW
• Rose Mary De Melo, PT, DPT
• Stephanie Elena Deluca, MD
• Donna Dempsey
• Kristina M Devine, RN
• Kelli Scarlett Devitte-McKee, CNP
• Gerard Distefano
• Dung My Doan, D.M.D.
• Caroline Doherty, RN

• Dentist in Charlestown, MA
• Providers in Charlestown, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.