Provider Type Icon

MS. DEREKA MCKISSACK MCKISSACK NPI 1124469705


NPI Information

NPI: 1124469705
Provider Name: MS. DEREKA MCKISSACK MCKISSACK
Classification: Dental Assistant - 126800000X
Entity Type: Individual
Address:
374 N DESHON RD STE D
STONE MOUNTAIN, GA
ZIP 30087
Phone: (770) 469-4192
Get Directions

MS. Dereka Mckissack Mckissack is a dental assistant in Stone Mountain, GA. The provider is an individual who may or may not have completed an accredited dental assisting education program and who aids the dentist in providing patient care services and performs other nonclinical duties in the dental office or other patient care facility. The scope of the patient care functions that may be legally delegated to the dental assistant varies based on the needs of the dentist the educational preparation of the dental assistant and state dental practice acts and regulations. Patient care services are provided under the supervision of a dentist. To avoid misleading the public, no occupational title other than dental assistant should be used to describe this dental auxiliary. MS. Dereka Mckissack Mckissack NPI is 1124469705. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

374 N DESHON RD STE D
STONE MOUNTAIN, GA
ZIP 30087-827
Phone: (770) 469-4192
Fax: (770) 469-4195

The enumeration date for this NPI number is 7/11/2013 and was last updated on 7/11/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1126800000XDental AssistantYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.