Provider Demographics
NPI:1073655429
Name:DEVIN, LANNIE EARL (DDS)
Entity Type:Individual
Prefix:
First Name:LANNIE
Middle Name:EARL
Last Name:DEVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LANNIE
Other - Middle Name:E
Other - Last Name:DEVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:810 FRONTAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:IDALOU
Mailing Address - State:TX
Mailing Address - Zip Code:79329
Mailing Address - Country:US
Mailing Address - Phone:806-892-2557
Mailing Address - Fax:806-892-3359
Practice Address - Street 1:810 FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:IDALOU
Practice Address - State:TX
Practice Address - Zip Code:79329
Practice Address - Country:US
Practice Address - Phone:806-892-2557
Practice Address - Fax:806-892-3359
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1502901OtherCHIP