Demion R Cornwall, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13699 Issued in MD

Practice address

6620 Crain Hwy
Suite 204
Laplata, MD 20646

Phone

(301) 870-3966

Fax

(301) 753-1992

NPI assigned

Jun 7, 2012

Sex

Male

Sole proprietor

No

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.

• Smalltowne Dental LLC

  • Dental Clinic/Center
  • La Plata, MD
  • NPI 1306642848
  NPD Authorized official
• O W John & Assc

  • General Practice Dentistry
  • La Plata, MO
  • NPI 1235142837

  General Practice

  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MD

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

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 7, 2012.

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339027200000",
    "number": "1982965711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 CRAIN HWY #204",
            "city": "LAPLATA",
            "state": "MD",
            "postal_code": "20646",
            "telephone_number": "301-870-3966",
            "fax_number": "301-753-1992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 CRAIN HWY",
            "address_2": "SUITE 204",
            "city": "LAPLATA",
            "state": "MD",
            "postal_code": "20646",
            "telephone_number": "301-870-3966",
            "fax_number": "301-753-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNWALL",
        "first_name": "DEMION",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-07",
        "last_updated": "2012-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "13699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Regional Surgical Center LLC
• Yufei Chen, STUDENT
• Lisa Chernoff, LCPC
• Kelly Clark
• Ann-Marie Natalee Cobb, PA-C
• Treeci Dean
• Markeeta Dixon, LGSW-C
• DRS Hertz and Idol DPM, PA
• DRS. Hertz and Idol,DPM
• Deborah Eddins

• All providers in Laplata, MD
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2012; 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.