Provider Demographics
NPI:1225237712
Name:DEVORE, MARIE KATHERINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:KATHERINE
Last Name:DEVORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BARRYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12719
Mailing Address - Country:US
Mailing Address - Phone:845-557-8500
Mailing Address - Fax:845-557-3306
Practice Address - Street 1:3411 S R 97
Practice Address - Street 2:
Practice Address - City:BARRYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12719
Practice Address - Country:US
Practice Address - Phone:845-557-8500
Practice Address - Fax:845-557-3306
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028077L122300000X
NY0410791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist