Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MS. DEREKA MCKISSACK MCKISSACK
Active Sole ProprietorMS. DEREKA MCKISSACK MCKISSACK is a Dental Assistant healthcare provider located in STONE MOUNTAIN, Georgia. NPI 1124469705 is currently active in the NPPES registry. Verify at CMS.
Dental Assistant · STONE MOUNTAIN, GA
Registration Details
- NPI Number
- 1124469705
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jul 11, 2013 (13.119686815983 yrs)
- Last Updated
- Jul 11, 2013
- Sole Proprietor
- Yes
Practice Information
- Address
-
374 N DESHON RD STE DSTONE MOUNTAIN, GA, 300874827Browse GA providers · Browse ZIP 30087
- Phone
- 7704694192
- Fax
- 7704694195
- Primary Specialty
-
Dental Assistant
126800000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.