DR. JOHN PETER DERDIVANIS (NPI# 1821024902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821024902 |
| Entity Type | Individual |
| Full Name | DR. JOHN PETER DERDIVANIS |
| Credential | DDS |
| Practice Address |
15600 Washington Ave.ste.e San Lorenzo CA 94580 |
| Practice Telephone | 5102768366 |
| Practice Fax Number | 5102761422 |
| Mailing Telephone | 5102768366 |
| Mailing Fax Number | 5102761422 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
15206 | CA | Dental Providers |
| Street Address |
15600 WASHINGTON AVE.STE.E |
| City | SAN LORENZO |
| State | CA |
| Zip Code | 94580 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497226047 | Sunrise Care Home LLC | Clinic/Center | 1447 Via Lucas, San Lorenzo, CA 94580 | 2018-12-07 |
| 1700370459 | Andrea Gisela Sanchez - Altamirano | Behavioral Analyst | 16215 Via Arriba Apt 205, San Lorenzo, CA 94580 | 2018-06-17 |
| 1700326030 | Cozy Physical Therapy | Clinic/Center | 16012 Via Granada, San Lorenzo, CA 94580 | 2017-03-06 |
| 1912255605 | Brandi S Gates | Lactation Consultant, Non-RN | 1474 Via Coralla, San Lorenzo, CA 94580 | 2012-08-28 |
| 1255525572 | Charlex Corp Usa | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 16829 Daryl Ave, San Lorenzo, CA 94580 | 2007-08-29 |
| 1194917187 | Charlex Corp Usa | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 16837 Daryl Ave, San Lorenzo, CA 94580 | 2007-08-14 |
| 1629136080 | Winston F Yee | Dentist | 17760 Hesperian Blvd, San Lorenzo, CA 94580 | 2006-12-05 |
| 1871686568 | Linh P Nguyen | Chiropractor | 15817 Channel Street, San Lorenzo, CA 94580 | 2006-10-02 |
| 1588104608 | Cozy Physical Therapy Professional Corporation | Clinic/Center | 16012 Via Granada, San Lorenzo, CA 94580 | 2017-03-08 |
| 1700017316 | Holly Jane Barbarisi | Marriage & Family Therapist | 11100 San Pablo Ave, #210, El Cerrito, CA 94580 | 2009-07-30 |
| Find all providers in zip 94580 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982204780 | Richard Koh Dds Ms Inc. | Dentist | 11 Delano, Irvine, CA 92602-2462 | 2020-10-30 |
| 1225641293 | Richard T. Kao, Dds, Phd - Dental Corp. | Dentist | 1660 Willow St Ste 3, San Jose, CA 95125-5101 | 2020-08-28 |
| 1093325722 | Sergio Florencio Jr, Dds, Dmsc, Inc | Dentist | 1802 San Miguel Dr, Walnut Creek, CA 94596-8606 | 2020-08-06 |
| 1205463445 | Sharona Dayan, Dds, Inc | Dentist | 9735 Wilshire Blvd Ste 211, Beverly Hills, CA 90212-2102 | 2020-03-26 |
| 1215573522 | Vanessa Bikhazi | Dentist | 2372 Se Bristol St Ste A, Newport Beach, CA 92660-0755 | 2019-11-21 |
| 1063057008 | Robert Lacrampe | Dentist | 880 W 1st St Apt 526, Los Angeles, CA 90012-2473 | 2019-11-13 |
| 1376194639 | Snow Nakano & Lopez Professional Dental Corporation | Dentist | 868 Auto Center Dr Ste A, Palmdale, CA 93551-4691 | 2019-09-26 |
| 1659926285 | Suman Ramakumar Dds Inc | Dentist | 1171 Homestead Rd Ste 175, Santa Clara, CA 95050-5484 | 2019-08-09 |
| 1912567058 | Andrew Peterson Dmd Ms PC | Dentist | 9856 Hibiscus Ct, Alta Loma, CA 91737-3637 | 2019-06-20 |
| 1124686233 | Danoukh Dental Corp. | Dentist | 12271 La Mirada Blvd Ste 201, La Mirada, CA 90638-1336 | 2019-06-04 |
| Find all providers with the same taxonomy | ||||
| City | SAN LORENZO |
| Zip Code | 94580 |
Please comment or provide details below to improve the information on DR. JOHN PETER DERDIVANIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.