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MS. DEREKA MCKISSACK MCKISSACK
NPI 1124469705
Dental Assistant in Stone Mountain, GA

Active since July 11, 2013
374 N DESHON RD STE D, STONE MOUNTAIN, GA 30087(770) 469-4192(770) 469-4195 Get Directions Write a Review

NPPES record last updated: July 11, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Dereka Mckissack Mckissack NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. DEREKA MCKISSACK MCKISSACK (NPI 1124469705) is an individual dental assistant in Stone Mountain, Georgia and active in the NPI registry since July 2013.

NPPES Registry Identity

NPI1124469705
Entity TypeIndividualFemale
Primary Taxonomy126800000X
Provider Legal NameMS. DEREKA MCKISSACK MCKISSACK
Location Address374 N DESHON RD STE DStone Mountain, GA 30087-4827
Mailing Address374 N Deshon Rd Ste DStone Mountain, GA 30087-4827 · (770) 469-4192 · Fax (770) 469-4195
Phone(770) 469-4192
Fax(770) 469-4195
Sole ProprietorYes
Enumeration DateJuly 11, 2013
✔ NPI 1124469705 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDental AssistantDental Providers
Taxonomy Code126800000X
Definition
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.
374 N DESHON RD STE D, Stone Mountain, GA 30087
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dereka Mckissack's NPI number?

The NPI number for Dereka Mckissack is 1124469705. It was assigned to this individual provider in the NPPES registry on July 11, 2013.

Where is Dereka Mckissack located?

Dereka Mckissack practices at 374 N Deshon Rd Ste D, Stone Mountain, GA 30087. The listed phone number is (770) 469-4192.

What is Dereka Mckissack's specialty?

The primary specialty registered for this NPI is Dental Assistant with taxonomy code 126800000X.

When was this NPI record last updated?

The NPPES record for Dereka Mckissack was last updated on July 11, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.