Provider Demographics
NPI:1740403435
Name:WILLIAM J DERKASCH CYRUS G DEHKAN PTRS
Entity Type:Organization
Organization Name:WILLIAM J DERKASCH CYRUS G DEHKAN PTRS
Other - Org Name:DERKASCH & DEHKAN DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DERKASCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-276-2225
Mailing Address - Street 1:409 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1538
Mailing Address - Country:US
Mailing Address - Phone:908-276-2225
Mailing Address - Fax:908-276-1550
Practice Address - Street 1:409 BOULEVARD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1538
Practice Address - Country:US
Practice Address - Phone:908-276-2225
Practice Address - Fax:908-276-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01560000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty