Provider Demographics
NPI:1033484332
Name:DEREK JAMES BEVANS DMD
Entity Type:Organization
Organization Name:DEREK JAMES BEVANS DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BEVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-686-1199
Mailing Address - Street 1:721 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6008
Mailing Address - Country:US
Mailing Address - Phone:541-686-1199
Mailing Address - Fax:541-686-3033
Practice Address - Street 1:721 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6008
Practice Address - Country:US
Practice Address - Phone:541-686-1199
Practice Address - Fax:541-686-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty