Samson S Derebe, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE00008442 Issued in WA

Practice address

6044 Martin Luther King Way So
Suite#101
Seattle, WA 98118-3179

Phone

(206) 760-9571

Fax

(206) 760-9627

NPI assigned

May 14, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Aim Dental Associates Inc

  • Denturist
  • Seattle, WA
  • NPI 1316071921
  NPD (past)

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962617548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6044 MARTIN LUTHER KING WAY SO",
            "address_2": "SUITE #101",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981183179",
            "telephone_number": "206-760-9571",
            "fax_number": "206-760-9627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6044 MARTIN LUTHER KING WAY SO",
            "address_2": "SUITE#101",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981183179",
            "telephone_number": "206-760-9571",
            "fax_number": "206-760-9627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREBE",
        "first_name": "SAMSON",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00008442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colleen Culley Deprez, LICSW
• Rachelle Depta
• Natalie Deraiche, MS
• Abnet Derar
• Diane Derboghosian
• Tatiana Deriugin, M.D.
• Taryn G Derke
• Elena Josephine Derkits, M.D.
• Andrew J Derksen-Schrock, MD
• Mark David Derleth, M.D.

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

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

Verify at the official NPI Registry.