MEDICARE: DEE ALLEN DEEVERS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2740	NV

General Provider Information

NPI Number	:	1336272681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEE ALLEN DEEVERS DDS

Provider Business Mailing Address
First Line	:	2651 N GREEN VALLEY PKY
Second Line	:	103D
City	:	HENDERSON
State	:	NV
Zip	:	89014
Country	:	US
Telephone Number	:	702-547-4653
Fax Number	:	702-547-3846

Provider Business Practice Location Address
First Line	:	2651 N GREEN VALLEY PKY
Second Line	:	103D
City	:	HENDERSON
State	:	NV
Zip	:	89014
Country	:	US
Telephone Number	:	702-547-4653
Fax Number	:	702-547-3846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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