Dergham Dergham, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30-023579 Issued in OH

Practice address

4785 Leavitt Rd
Lorain, OH 44053-2136

Phone

(440) 282-6677

NPI assigned

Nov 14, 2011

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

Enrolled in CA

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

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.

• Dental Professionals Cleveland-Nouneh, Inc.

  • Dental Clinic/Center
  • Lorain, OH
  • NPI 1821272048
  NPD (past)

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321228800000",
    "number": "1396022703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4785 LEAVITT ROAD",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "44053",
            "telephone_number": "440-282-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4785 LEAVITT RD",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440532136",
            "telephone_number": "440-282-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERGHAM",
        "first_name": "DERGHAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-14",
        "last_updated": "2011-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30-023579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Louise Denillo
• Carlotta Louise Denney, LPN
• Felicia Densmore, MSW, LSW
• Dental Professionals Cleveland-Nouneh, Inc.
• Rochelle Deoliveira
• Carleen Jean Destro, LPN
• Madison Hope Dever
• Lizbeth Diaz Gonzalez
• Tammy Dickerson
• Cathy Didion, P.T.

• Pediatric Dentistry in Lorain, OH
• Providers in Lorain, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.