Provider Demographics
NPI:1033276175
Name:DEVACK, JEFFREY EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDWIN
Last Name:DEVACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PACKANACK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7420
Mailing Address - Country:US
Mailing Address - Phone:973-696-5333
Mailing Address - Fax:
Practice Address - Street 1:95 PACKANACK LAKE RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7420
Practice Address - Country:US
Practice Address - Phone:973-696-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ100021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics