Provider Demographics
NPI:1235299694
Name:DEVYLDER, JOSEPH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:DEVYLDER
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 1:407 F CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4737
Mailing Address - Country:US
Mailing Address - Phone:703-938-5664
Mailing Address - Fax:703-938-4605
Practice Address - Street 1:407 F CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4737
Practice Address - Country:US
Practice Address - Phone:703-938-5664
Practice Address - Fax:703-938-4605
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA048311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery