Provider Demographics
NPI:1346620242
Name:DEVASIA, JEENA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEENA
Middle Name:ELIZABETH
Last Name:DEVASIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 OLD CHESTERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4741
Mailing Address - Country:US
Mailing Address - Phone:703-356-9264
Mailing Address - Fax:
Practice Address - Street 1:6707 OLD DOMINION DR
Practice Address - Street 2:SUITE 240
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4504
Practice Address - Country:US
Practice Address - Phone:703-734-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist