Provider Demographics
NPI:1114253465
Name:DEVARAJ, ALWYN STEAVE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALWYN
Middle Name:STEAVE
Last Name:DEVARAJ
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 1:4118 W POINT LOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5605
Mailing Address - Country:US
Mailing Address - Phone:619-225-9354
Mailing Address - Fax:619-225-8365
Practice Address - Street 1:4118 W POINT LOMA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5605
Practice Address - Country:US
Practice Address - Phone:619-225-9354
Practice Address - Fax:619-225-8365
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist