Healthcare Provider Details

I. General information

NPI: 1811389851
Provider Name (Legal Business Name): JOSEPH DEVEAUX DENTAL HYGIENIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD # 5B13
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

48320 VANDERBERG CT
SOLDOTNA AK
99669-9466
US

V. Phone/Fax

Practice location:
  • Phone: 907-283-9125
  • Fax:
Mailing address:
  • Phone: 907-252-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberAA588
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: