Basic Information
| Provider Information | |||||||||
| NPI: | 1194319368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DERMARKARIAN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1833 SWEETWATER WEST CIR | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327122483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079257021 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 65 W MITCHELL HAMMOCK RD STE 1511 | ||||||||
| Address2: | |||||||||
| City: | OVIEDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327656969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076040399 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2021 | ||||||||
| LastUpdateDate: | 04/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 11749 | TN | N | Dental Providers | Dentist | 122300000X | DN26594 | FL | Y | Dental Providers | Dentist |
No ID Information.