Derek Van Dyke, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30-024005 Issued in OH

Practice address

1190 Independence Ave
Marion, OH 43302-6318

Phone

(740) 382-5535

NPI assigned

Jun 21, 2013

Last updated

Jun 21, 2013By the provider in NPPES

Sex

Male

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

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1558700666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 FOREST LAWN BLVD",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433024370",
            "telephone_number": "402-980-2972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 INDEPENDENCE AVE",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433026318",
            "telephone_number": "740-382-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYKE",
        "first_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-21",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-024005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• United Church Homes, Inc.
• Jada Lynn Urquhart, LISW
• Elizabeth Usher, BSN, RN
• Joshua Utley
• Amy L Vaflor, CRNA
• Margaret Brite Van Meter, LISW-S
• Michael Varchulik, PRS
• Kelsie Ann Vaske, CT
• Veera Chandra Sekhar Veerla, MD
• Megan Venturino

• General Practice Dentistry in Marion, OH
• Providers in Marion, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; 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.