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General NPI Number Information
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NPI Number | 1659544617
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Entity Type | Organization
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Legal Business Name | DAVID M DEVIESE DDS PC
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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 | 306 S MAIN ST
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City | MADISON
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State | VA
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Zip | 22727-3026
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Country | US
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Telephone | 540-948-4488
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Fax | 540-948-4662
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Provider Business Mailing Address
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Address Line | PO BOX 304
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City | MADISON
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State | VA
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Zip | 22727-0304
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Country | US
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Telephone | 540-948-4488
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Fax | 540-948-4662
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID MYERS DEVIESE
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Credential | DDS
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Telephone | 540-948-4488
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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 | 0401004401
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License Number State | VA
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