Leah T Deberardinis

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

51523 Issued in CA

Practice address

511 Hayes LN
Petaluma, CA 94952-4011

Phone

(707) 763-2654

Fax

(707) 763-3141

NPI assigned

May 31, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Leah Deberardinis DDS and Austin Griffith DDS a Dental Corporation

  • General Practice Dentistry
  • Petaluma, CA
  • NPI 1316969496
  NPD (past) Authorized official

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309392000000",
    "number": "1396947693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 WALLENBERG WAY",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949524786",
            "telephone_number": "707-799-7344",
            "fax_number": "707-763-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 HAYES LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949524011",
            "telephone_number": "707-763-2654",
            "fax_number": "707-763-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBERARDINIS",
        "first_name": "LEAH",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2011-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "51523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Preeya Desai De Silva
• Kaytlyn Dean Haynes
• Christie Deann Dean
• Meya Teresa Dean
• Jessie 'Lori' Deans
• Marc Callen Deberardinis, D.M.D., M.S.
• Debra Grant
• Jason Debrovner, RBT
• Tricia Nicole Decarli
• Karen Decarlo, CD

• General Practice Dentistry in Petaluma, CA
• Providers in Petaluma, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2011; 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.