MEDICARE: DR. DEVIN LEE DEZERN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	23981	TX

General Provider Information

NPI Number	:	1316108236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVIN LEE DEZERN D.D.S.

Provider Business Mailing Address
First Line	:	7700 GREENWAY BLVD
Second Line	:	#H103
City	:	DALLAS
State	:	TX
Zip	:	75209-7323
Country	:	US
Telephone Number	:	214-930-2312
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 GREENWAY BLVD
Second Line	:	#H103
City	:	DALLAS
State	:	TX
Zip	:	75209-7323
Country	:	US
Telephone Number	:	214-930-2312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	04/09/2013

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