Individual provider · Type 1 NPI
Gay M. Derderian, DDS
Periodontics · Milwaukee, WI
NPI number
1548356702
Active
Practice location
1801 West Wisconsin Ave
Milwaukee, WI 53233
Fax (414) 288-0678
Mailing address
PO Box 1881
Milwaukee, WI 53201-1881
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Periodontics Primary | 1223P0300X | 3370015 (WI) |
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.
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About NPI 1548356702
Gay M. Derderian, DDS's National Provider Identifier is 1548356702, issued on Oct 5, 2006. The primary taxonomy on file is Periodontics (1223P0300X), and the practice location is in Milwaukee, WI. The record was last updated on Jul 8, 2007.