Provider Demographics
NPI:1043483100
Name:DR. ERROL DEVEAUX & ASSOCIATES FAMILY DENTISTRY, PSC
Entity Type:Organization
Organization Name:DR. ERROL DEVEAUX & ASSOCIATES FAMILY DENTISTRY, PSC
Other - Org Name:DEVEAUX DENTAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:270-352-4343
Mailing Address - Street 1:309 N. WILSON RD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2194
Mailing Address - Country:US
Mailing Address - Phone:270-352-4343
Mailing Address - Fax:270-352-2323
Practice Address - Street 1:309 N. WILSON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2194
Practice Address - Country:US
Practice Address - Phone:270-352-4343
Practice Address - Fax:270-352-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6006705500Medicaid