Gay M Derderian, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

3370015 Issued in WI

Practice address

1801 West Wisconsin Ave
Milwaukee, WI 53233

Phone

(414) 288-0788

Fax

(414) 288-0678

NPI assigned

Oct 5, 2006

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

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 Jun 21, 2016 through Jun 21, 2028

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.

• Marquette University

  • General Practice Dentistry
  • Milwaukee, WI
  • NPI 1013937499

  Periodontics

  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548356702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1881",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532011881",
            "telephone_number": "414-288-0788",
            "fax_number": "414-288-0678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 WEST WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53233",
            "telephone_number": "414-288-0788",
            "fax_number": "414-288-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERDERIAN",
        "first_name": "GAY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WI",
            "license": "3370015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Depledge, D.D.S.
• Dept. of Veterans Affairs
• Jeremiah Peter Depta, M.D.
• Patricia Dequardo, RDH
• Mirella Francesca Derango, PHARM.D.
• Michele Derdzinski
• Terrance E. Derks, PA-C
• Jill Marie Derler
• Dermatology Associates SC
• Carl Scott Dernell

• Periodontics in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Periodontics in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.