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General NPI Number Information
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NPI Number | 1659476810
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Entity Type | Individual
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Provider Name | SUSAN M DEVERA DMD
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14393 WASHINGTON AVE SUITE B
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City | SAN LEANDRO
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State | CA
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Zip | 94578-3430
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Country | US
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Telephone | 510-667-0201
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Fax | 510-667-0204
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Provider Business Mailing Address
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Address Line | 14393 WASHINGTON AVE SUITE B
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City | SAN LEANDRO
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State | CA
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Zip | 94578-3430
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Country | US
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Telephone | 510-667-0201
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Fax | 510-667-0204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45677
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License Number State | CA
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