Provider Demographics
NPI:1689913089
Name:DEVEREUX AND NGUYEN LLC
Entity Type:Organization
Organization Name:DEVEREUX AND NGUYEN LLC
Other - Org Name:DEVEREUX AND NGUYEN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVEREUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-368-3932
Mailing Address - Street 1:111 LAKEWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-3002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 LAKEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-3002
Practice Address - Country:US
Practice Address - Phone:985-785-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty