Active NPI
Mark Deukmedjian, D.D.S., M.S.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Northridge, CA
National Provider Identifier
1992831812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 43778
- Practice address
- 11155 Tampa Ave
Northridge, CA 91326-2254 - Phone
- (818) 360-3636
- Fax
- (818) 363-4002
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 43778 | CA | Primary |
Addresses
Primary practice location
11155 Tampa Ave
Northridge, CA 91326-2254
Mailing address
12018 Louise Ave
Granada Hills, CA 91344-2450
Phone (818) 723-9015
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43778 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992831812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12018 LOUISE AVE",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913442450",
"telephone_number": "818-723-9015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11155 TAMPA AVE",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913262254",
"telephone_number": "818-360-3636",
"fax_number": "818-363-4002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEUKMEDJIAN",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "43778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northridge, CA
Sources for this page
- 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.