Eric Derovanessian, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

7600 Issued in WA

Practice address

15710 NE 24TH St
Suite B
Bellevue, WA 98008-2444

Phone

(425) 644-6802

Fax

(425) 644-1426

NPI assigned

Jun 7, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Institute of Cosmetic Dentistry

  dba Eric Der Ovanessian DDS PS Inc

  • Dentist
  • Bellevue, WA
  • NPI 1194898379
  NPD (past) Authorized official

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370563200000",
    "number": "1831537224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15710 NE 24TH ST",
            "address_2": "SUITE B",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980082444",
            "telephone_number": "425-644-6802",
            "fax_number": "425-644-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15710 NE 24TH ST",
            "address_2": "SUITE B",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980082444",
            "telephone_number": "425-644-6802",
            "fax_number": "425-644-1426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROVANESSIAN",
        "first_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-07",
        "last_updated": "2013-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "7600",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "39144",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5034913",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Deramo, LMP
• Tatjana Deretic, M.D.
• Dermatology Arts, PLLC (Dermatology Arts)
• Dermatopatholoty Northwest PLLC (Carlsen Histopath)
• Jessica Laura Deroche, LMT
• Nicolaas Piet Deruyter, MD
• Arzu Dervish
• Vicki A Deshazo
• Aarti R Deshpande, M.D.
• Anna A Desimone, L.M.P.

• Dentist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.