Provider Demographics
NPI:1124409487
Name:DEVITO, DAVID MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:DEVITO
Suffix:
Gender:M
Credentials:DMD
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Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET, RM. D104
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-323-3368
Mailing Address - Fax:859-257-5859
Practice Address - Street 1:800 ROSE STREET, RM. D104
Practice Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:859-323-3368
Practice Address - Fax:859-257-5859
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY95981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100434250Medicaid