Provider Demographics
NPI:1558310961
Name:PEOPLES, DEVETA (DENTIST)
Entity Type:Individual
Prefix:
First Name:DEVETA
Middle Name:
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 AVENUE E
Mailing Address - Street 2:WESTERN HEALTH CENTER
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218-1543
Mailing Address - Country:US
Mailing Address - Phone:205-241-5277
Mailing Address - Fax:
Practice Address - Street 1:1700 AVENUE E
Practice Address - Street 2:WESTERN HEALTH CENTER
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1543
Practice Address - Country:US
Practice Address - Phone:205-241-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-06353 CENTRALOtherBLUE CROSS BLUE SHIELD
AL510-06354OtherBLUE CROSS BLUE SHIELD
AL510-06361 EASTERNOtherBLUE CROSS BLUE SHIELD
AL51512819PEOOtherWESTERN LOCATION
AL510-06361 EASTERNOtherBLUE CROSS BLUE SHIELD