Provider Demographics
NPI:1831391515
Name:DERAGOPIAN, DIKRAN (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:DIKRAN
Middle Name:
Last Name:DERAGOPIAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 STONEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4418
Mailing Address - Country:US
Mailing Address - Phone:859-264-0365
Mailing Address - Fax:
Practice Address - Street 1:4411 BALFOUR RD STE B
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1526
Practice Address - Country:US
Practice Address - Phone:859-494-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY77761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery