Disick Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DISICK DENTAL CORPORATION

Practice address

591 Redwood Hwy
Building 2000, Suite 2110
Mill Valley, CA 94941-6001

Phone

(415) 381-4321

Fax

(415) 381-4056

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Evan Schaffer Disick, D.D.S.NPI 1538182084

Title

President

Phone

(415) 381-4321

Specialties & licenses 1

Addresses

Other names 1

• EVAN S. DISICK, D.D.S. Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Evan Schaffer Disick, D.D.S.

  • General Practice Dentistry
  • Mill Valley, CA
  • NPI 1538182084
  NPD (past) Authorized official

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821019407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 REDWOOD HWY",
            "address_2": "BUILDING 2000, SUITE 2110",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949416001",
            "telephone_number": "415-381-4321",
            "fax_number": "415-381-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 REDWOOD HWY",
            "address_2": "BUILDING 2000, SUITE 2110",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949416001",
            "telephone_number": "415-381-4321",
            "fax_number": "415-381-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISICK DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DISICK",
        "authorized_official_first_name": "EVAN",
        "authorized_official_middle_name": "SCHAFFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-381-4321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVAN S. DISICK, D.D.S.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ron Destefano, PH.D.
• Maryse Devost-Varriale, RPH
• Cara Marie Devries, CARA DEVRIES
• Cooper Differding, D.D.S
• Janet Croce Disanto, MFT
• Evan Schaffer Disick, D.D.S.
• Sharon Marie Dittmer, D.C.
• Christine Marie Donohue, M.A.
• Douglas E. Cohen MD, Inc.
• Lori Mae Douglass, NP, MS, CCM

• General Practice Dentistry in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.