Active NPI
Douglas Norman Dederich, DDS, PHD
- Periodontics
- Glendale, WI
National Provider Identifier
1932949203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 3322-15
- Practice address
- 500 W Silver Spring Dr Ste K250
Glendale, WI 53217-5062 - Phone
- (414) 963-2301
- NPI assigned
- May 25, 2024
- Last updated
- May 25, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 3322-15 | WI | Primary |
Addresses
Primary practice location
500 W Silver Spring Dr Ste K250
Glendale, WI 53217-5062
Mailing address
6330 W Greenfield Ave Apt 408
Milwaukee, WI 53214-5073
Phone (780) 868-1562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3322-15 | WI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716595200000",
"number": "1932949203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6330 W GREENFIELD AVE APT 408",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532145073",
"telephone_number": "780-868-1562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W SILVER SPRING DR STE K250",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532175062",
"telephone_number": "414-963-2301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDERICH",
"first_name": "DOUGLAS",
"middle_name": "NORMAN",
"credential": "DDS, PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-25",
"last_updated": "2024-05-25",
"certification_date": "2024-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WI",
"license": "3322-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, WI
- Tiffany A Darling, MD
- Nicola Alexandra Davidson-Ali, OTR/L
- Elisabeth Ann Davis, P.T.
- Margo Elisha Dawson
- Jack Hudson Deckard, MD
- Deerwood Orthodontics, LLC (Deerwood Orthodontics Bayshore)
- Amanda Joann Degner, LPC
- Eduardo Enrique Delgado, MD
- Dennis L Merritt LCSW PHD SC
- B. Hal Dessel, LCSW, CADC III
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.