Provider Demographics
NPI:1275977282
Name:DERMESROPIAN, JOHN AGOP (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AGOP
Last Name:DERMESROPIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2018
Mailing Address - Country:US
Mailing Address - Phone:315-744-6252
Mailing Address - Fax:
Practice Address - Street 1:1338 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2018
Practice Address - Country:US
Practice Address - Phone:315-744-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice