Provider Demographics
NPI:1144321258
Name:BRANDON E. DEVITO, DDS, PLLC
Entity type:Organization
Organization Name:BRANDON E. DEVITO, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-755-6788
Mailing Address - Street 1:20 MEDICAL CAMPUS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4096
Mailing Address - Country:US
Mailing Address - Phone:910-755-6788
Mailing Address - Fax:910-755-6789
Practice Address - Street 1:20 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4096
Practice Address - Country:US
Practice Address - Phone:910-755-6788
Practice Address - Fax:910-755-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty