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General NPI Number Information
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NPI Number | 1053887687
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Entity Type | Individual
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Provider Name | DEREK APPELBLATT DDS
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Gender | Male
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 276 KINGSBURY GRADE STE 1050
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City | STATELINE
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State | NV
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Zip | 89449-9804
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Country | US
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Telephone | 775-580-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 1984 MARCONI WAY
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6634
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Country | US
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Telephone | 916-769-3756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS102685
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License Number State | CA
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