Individual provider Active NPI

Cindy Michelle Derer, DMD

  • General Practice Dentistry
  • Lexington, KY
National Provider Identifier
1679620504
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5291 Issued in KY
Practice address
698 Perimeter Dr
Lexington, KY 40517-4141
Phone
(859) 268-9090
Fax
(859) 266-2410
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5291 KY Primary

Addresses

Primary practice location

698 Perimeter Dr
Lexington, KY 40517-4141

Mailing address

698 Perimeter Dr
Lexington, KY 40517-4141
Phone (859) 268-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130710000549 KY Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9638366495

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5291KYMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679620504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "698 PERIMETER DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405174141",
            "telephone_number": "859-268-9090",
            "fax_number": "859-266-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "698 PERIMETER DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405174141",
            "telephone_number": "859-268-9090",
            "fax_number": "859-266-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERER",
        "first_name": "CINDY",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.