Provider Demographics
NPI:1144219536
Name:DERMESROPIAN, CAROL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:DERMESROPIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446
Mailing Address - Country:US
Mailing Address - Phone:201-327-1311
Mailing Address - Fax:201-818-5096
Practice Address - Street 1:133 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446
Practice Address - Country:US
Practice Address - Phone:201-327-1311
Practice Address - Fax:201-818-5096
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02336700122300000X
NY050756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02439238Medicaid