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General NPI Number Information
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NPI Number | 1710237102
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Entity Type | Organization
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Legal Business Name | MICHAEL J. DEVEREUX DDS, PC
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 2477 OAKMONT WAY
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City | EUGENE
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State | OR
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Zip | 97401-6460
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Country | US
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Telephone | 541-484-1292
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Fax | 541-484-1294
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Provider Business Mailing Address
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Address Line | 2477 OAKMONT WAY
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City | EUGENE
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State | OR
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Zip | 97401-6460
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Country | US
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Telephone | 541-484-1292
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Fax | 541-484-1294
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Authorized Official
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Title or Position | FRONT OFFICE
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Name | MRS. JULI MEADOR
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Credential |
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Telephone | 541-484-1292
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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 | D6466
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License Number State | OR
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