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General NPI Number Information
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NPI Number | 1366806820
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Entity Type | Organization
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Legal Business Name | DEVEREUX AND NGUYEN
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 2201 VETERANS BLVD. SUITE 306
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City | METAIRIE
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State | LA
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Zip | 70002
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Country | US
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Telephone | 504-831-2120
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 VETERANS BLVD. SUITE 306
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City | METAIRIE
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State | LA
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Zip | 70002
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Country | US
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Telephone | 504-831-2120
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELLE VANBENSCHOTEN
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Credential |
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Telephone | 870-834-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3676
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License Number State | LA
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