Provider Demographics
NPI:1689824229
Name:MATTHEW W. DEVANEY, D.D.S. & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MATTHEW W. DEVANEY, D.D.S. & ASSOCIATES PLLC
Other - Org Name:SUMMERFIELD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEVANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-643-1440
Mailing Address - Street 1:6161 LAKE BRANDT RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-8415
Mailing Address - Country:US
Mailing Address - Phone:336-643-1440
Mailing Address - Fax:336-643-1065
Practice Address - Street 1:6161 LAKE BRANDT RD UNIT A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8415
Practice Address - Country:US
Practice Address - Phone:336-643-1440
Practice Address - Fax:336-643-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC69741223G0001X
NCNC82371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty