Dikran Deragopian, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7776 Issued in KY

Practice address

4411 Balfour Rd Ste B
Brentwood, CA 94513-1526

Phone

(859) 494-7334

NPI assigned

Jun 4, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831391515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 STONEWOOD LN",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405094418",
            "telephone_number": "859-264-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 BALFOUR RD STE B",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945131526",
            "telephone_number": "859-494-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERAGOPIAN",
        "first_name": "DIKRAN",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "7776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Therese Marie Delgado
• Yazmeen Delosreyes
• Delta Vista Optometry Inc.
• Anthony Demaria
• Caitlin Depaola
• Anthony Derenzi-Hilt, DPT
• Lisa S Derita, FNP
• Nilima Nailinbhai Desai, M.D.
• Manraj K Dhaliwal, DDS
• Susan Dhami

• Oral and Maxillofacial Surgery (Dentist) in Brentwood, CA
• Providers in Brentwood, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.