Mitra Derakhshan, DDS MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12731 Issued in MD

Practice address

5082 Dorsey Hall Dr Ste 202
Ellicott City, MD 21042-7754

Phone

(202) 445-4972

NPI assigned

Dec 1, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1512086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1962916783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 GRANT ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5082 DORSEY HALL DR STE 202",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427754",
            "telephone_number": "202-445-4972"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5820 Clarksville Square Dr Ste 104",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "MD",
            "postal_code": "210291856",
            "country_code": "US",
            "telephone_number": "202-445-4972",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERAKHSHAN",
        "first_name": "MITRA",
        "name_prefix": "Dr.",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-01",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "DC",
            "license": "DEN1000677",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "49090",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MD",
            "license": "12731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Dellota, DPT, PT
• Mirka Denis
• Robert J Denmark, LCPC
• Ruth Prendergast Dennison-Tedesco, PHD
• Roxanne Depietro-Hartman, OTR/L
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• Dermatology & Advanced Skin Care, Inc.
• Helen E. Derossi, LCSW-C
• Chetna Kartik Desai, D.D.S.
• Kartik J Desai, MD

• Orthodontics and Dentofacial Orthopedics Dentistry in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.