Healthcare Provider Details

I. General information

NPI: 1396663043
Provider Name (Legal Business Name): DEVGON ORTHODONTICS, PPLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 W WHITESTONE BLVD STE 150
CEDAR PARK TX
78613-8005
US

IV. Provider business mailing address

1201 MORNING MOON CIR
AUSTIN TX
78732-6145
US

V. Phone/Fax

Practice location:
  • Phone: 904-868-3495
  • Fax:
Mailing address:
  • Phone: 904-868-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DENISE DEVGON
Title or Position: ORTHODONTIST
Credential: DDS, MS
Phone: 904-868-3495