Maryam Ruby Kishta-Derani, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2901019672 Issued in MI

Practice address

2815 S Pennsylvania Ave
Suite 203
Lansing, MI 48910-3496

Phone

(517) 272-4150

NPI assigned

Aug 20, 2007

Sex

Female

Sole proprietor

Yes

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 MI

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.

• County of Ingham

  • Public Health or Welfare Agency
  • Lansing, MI
  • NPI 1902453145
  NPD (past)

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187568000000",
    "number": "1407049810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6633 WESTWOOD CT",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483221371",
            "telephone_number": "248-408-3136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 S PENNSYLVANIA AVE",
            "address_2": "SUITE 203",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489103496",
            "telephone_number": "517-272-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHTA-DERANI",
        "first_name": "MARYAM",
        "middle_name": "RUBY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-20",
        "last_updated": "2007-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khristine Marie Kirkbride, DPT, OMPT
• Lora Kirkbride
• Vincent Jeremiah Kirrmann I
• Celina Ann Kirsch, PA
• Justin Sasky Kisaka, DO
• Anna Kislik
• Isabella Kiss
• Amy Klaes, MA
• Raina Klaver, DO
• George E Kleiber, DO

• Dentist in Lansing, MI
• Providers in Lansing, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2007; 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.