Provider Demographics
NPI:1083749048
Name:DEVIGAL, ALEX D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:D
Last Name:DEVIGAL
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 1:137 FLYING DUTCHMAN CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7726
Mailing Address - Country:US
Mailing Address - Phone:707-554-0337
Mailing Address - Fax:
Practice Address - Street 1:917 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2301
Practice Address - Country:US
Practice Address - Phone:510-525-2266
Practice Address - Fax:510-525-9429
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL421441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice