Provider Demographics
NPI:1154493187
Name:DEVIRION, BEATA REGINA (DDS)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:REGINA
Last Name:DEVIRION
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BEATA
Other - Middle Name:REGINA
Other - Last Name:DEVIRION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:250 W KENSINGTON RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1293
Mailing Address - Country:US
Mailing Address - Phone:847-253-7070
Mailing Address - Fax:
Practice Address - Street 1:250 W KENSINGTON RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1293
Practice Address - Country:US
Practice Address - Phone:847-253-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190229811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice