NPIMap

Organization Active NPI

Churchton Dental Care

  • Prosthodontics
  • Churchton, MD
National Provider Identifier
1548514730
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
Legal business name
CHURCHTON DENTAL CARE
Practice address
5570 Shady Side Rd
Unit a
Churchton, MD 20733-9639
Phone
(443) 294-2025
NPI assigned
Nov 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Authorized official

Name
Dr. Graham Dersley, D.D.S.
Title
Owner
Phone
(443) 294-2025

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X Primary

Addresses

Primary practice location

5570 Shady Side Rd
Unit a
Churchton, MD 20733-9639

Mailing address

5570 Shady Side Rd
Unit a
Churchton, MD 20733-9639

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352419200000",
    "number": "1548514730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5570 SHADY SIDE RD",
            "address_2": "UNIT A",
            "city": "CHURCHTON",
            "state": "MD",
            "postal_code": "207339639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5570 SHADY SIDE RD",
            "address_2": "UNIT A",
            "city": "CHURCHTON",
            "state": "MD",
            "postal_code": "207339639",
            "telephone_number": "443-294-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCHTON DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-09",
        "last_updated": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "DERSLEY",
        "authorized_official_first_name": "GRAHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-294-2025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Churchton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.