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General NPI Number Information
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NPI Number | 1043483100
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Entity Type | Organization
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Legal Business Name | DR. ERROL DEVEAUX & ASSOCIATES FAMILY DENTISTRY, PSC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 309 N. WILSON RD
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City | RADCLIFF
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State | KY
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Zip | 40160-2194
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Country | US
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Telephone | 270-352-4343
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Fax | 270-352-2323
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Provider Business Mailing Address
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Address Line | 309 N. WILSON RD
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City | RADCLIFF
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State | KY
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Zip | 40160-2194
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Country | US
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Telephone | 270-352-4343
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Fax | 270-352-2323
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Authorized Official
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Title or Position | CEO
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Name | DR. ERROL DEVEAUX
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Credential | DDS
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Telephone | 270-352-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6705
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License Number State | KY
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