Provider Demographics
NPI:1780733683
Name:DEMERJIAN, RICHARD STEPHEN (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEPHEN
Last Name:DEMERJIAN
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 1:300 E LONG LAKE RD
Mailing Address - Street 2:ST 311 GREAT EXPRESSION DENTAL CENTERS
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276 BARNSTABLE RD
Practice Address - Street 2:NORTHEAST DENTAL
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-771-0500
Practice Address - Fax:508-771-0503
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist