Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1942866280 Individual Practitioner Male Practitioner

Dr. Tadele Demisse , DMD

Dentist - General Practice • Philadelphia, PA

Professional Overview & Biography Verified Profile Summary

Dr. Tadele Demisse, DMD is a registered healthcare professional specializing in Dentist - General Practice in Philadelphia, PA. Practice services are available at 6120B WOODLAND AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

6120b Woodland Ave

Philadelphia, PA 191423224

Telephone 2675973600
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Philadelphia, PA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 16.0 Yrs
State Avg: 19.0 Yrs
Regional Practice Density
577 Specialists

Practicing in Philadelphia, PA (4936 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-12-28
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License PA DS043969

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Dentist - General Practice

NUCC Taxonomy Code: 1223G0001X

State License NY 061697

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
02995513 (NY)
Medicaid State Provider ID
10000017080506 (PA)
Commercial Insurance / Payer ID Pin
53099A (NY)
Commercial Insurance / Payer ID Oscar
331833 (NY)

Secondary Practice Locations

1044 State St

Schenectady, NY 123071508

Phone: 5183701441

4700 Wissahickon Ave Ste 118

Philadelphia, PA 191444248

Phone: 2675973600

850 N 11th St

Philadelphia, PA 191231957

Phone: 2675973600

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

15 Associated Practitioners
NPI 1255842241
Elizabeth Somsanith

Social Worker - Clinical

NPI 1316356652
NPI 1326591744

Doctor of Psychology (Psy.D.)

Kanitra Fitzpatrick , CRNP

Nurse Practitioner - Family

NPI 1376934992

Certified Registered Nurse Practitioner

NPI 1497130868

Doctor of Dental Medicine

NPI 1538686829

Registered Dental Hygienist, PHDHP

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
📍
Updated Practice Location December 28, 2023

Registered at 6120B WOODLAND AVE, PHILADELPHIA, PA 191423224 (Tel: 2675973600)

📍
Updated Business Mailing Address December 28, 2023

Registered at 4700 WISSAHICKON AVE, PHILADELPHIA, PA 191444248 (Tel: 2675973600)

📍
Updated Business Mailing Address July 21, 2021

Registered at 1044 STATE ST, SCHENECTADY, NY 123071508 (Tel: 5183701441)

👤
Provider Name / Credentials Updated July 21, 2021

Recorded as TADELE DEMISSE, DMD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 21, 2021

Dentist (License #061697 in NY)

NPI Profile Active May 13, 2019

NPI status registered as active in NPPES database

📍
Updated Practice Location May 13, 2019

Registered at 1044 STATE ST, SCHENECTADY, NY 123071508 (Tel: 2672056213)

📍
Updated Business Mailing Address May 13, 2019

Registered at 544 FOOTHILL RD, BRIDGEWATER, NJ 088072139 (Tel: 2672056213)

👤
Provider Name / Credentials Updated May 13, 2019

Recorded as TADELE DEMISSE

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 13, 2019

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration May 13, 2019

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1942866280
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 13, 2019
Last Update: December 28, 2023
Sole Proprietor: No

Mailing Address

4700 Wissahickon Ave

Philadelphia, PA 191444248

Phone: 2675973600

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.