Dmitry Peysakhov, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE 60498667 Issued in WA

Practice address

1416 Highlands Dr NE
Suite 120
Issaquah, WA 98029-6240

Phone

(781) 856-8080

NPI assigned

Jul 22, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 22, 2016 through Sep 22, 2026

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.

• Steen and Peysakhov PLLC

  dba Bothell Oral, Maxillofacial & Implant Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Bothell, WA
  • NPI 1396557088
  NPD (past)

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441152000000",
    "number": "1477718229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4047 258TH WAY SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980297763",
            "telephone_number": "781-856-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 HIGHLANDS DR NE",
            "address_2": "SUITE 120",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980296240",
            "telephone_number": "781-856-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEYSAKHOV",
        "first_name": "DMITRY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-22",
        "last_updated": "2015-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS038644",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE 60498667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frida Rineth Pena Benitez, MD
• Juanjuan Peng
• Douglas Luther Perkins, DDS
• Peter D.a. Huysing, DMD, PLLC (Issaquah Dental Arts)
• Nicole Peter
• Lele Pham, RPH
• Phenix Physical Therapy & Personal Wellness, LLC
• Brittany C Philio, PA-C
• Michael J Phillips, PSY.D.
• Vivien Johnette Phillips, PSY.D.

• Oral and Maxillofacial Surgery (Dentist) in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.