Provider Demographics
NPI:1619172210
Name:DEVILLE, MARILYN LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:LOUISE
Last Name:DEVILLE
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 1:47 PAPWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4203
Mailing Address - Country:US
Mailing Address - Phone:504-309-8188
Mailing Address - Fax:
Practice Address - Street 1:3414 HESSMER AVE STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4748
Practice Address - Country:US
Practice Address - Phone:504-889-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853518Medicaid