NPIMap

Individual provider Active NPI

Graham Michael Dersley, D.D.S., M.S.

  • Prosthodontics
  • Burtonsville, MD
National Provider Identifier
1427229780
Registry record updated Jan 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
14033 Issued in MD
Practice address
3905 National Dr
Suite 260
Burtonsville, MD 20866-1100
Phone
(301) 421-1996
Fax
(240) 455-4922
NPI assigned
Mar 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 14033 MD Primary

Addresses

Primary practice location

3905 National Dr
Suite 260
Burtonsville, MD 20866-1100

Mailing address

3905 National Dr
Suite 260
Burtonsville, MD 20866-1100
Phone (301) 421-1996

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
14033MDMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Burtonsville Dental Group LLC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231459200000",
    "number": "1427229780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 NATIONAL DR",
            "address_2": "SUITE 260",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208661100",
            "telephone_number": "301-421-1996",
            "fax_number": "240-455-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 NATIONAL DR",
            "address_2": "SUITE 260",
            "city": "BURTONSVILLE",
            "state": "MD",
            "postal_code": "208661100",
            "telephone_number": "301-421-1996",
            "fax_number": "240-455-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSLEY",
        "first_name": "GRAHAM",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-14",
        "last_updated": "2009-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MD",
            "license": "14033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burtonsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; 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.