Provider Demographics
NPI:1699000869
Name:BRIAN J DEVOE DDS PA
Entity Type:Organization
Organization Name:BRIAN J DEVOE DDS PA
Other - Org Name:DEVOE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DEVOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:651-490-3155
Mailing Address - Street 1:700 VILLAGE CENTER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-3020
Mailing Address - Country:US
Mailing Address - Phone:651-490-3155
Mailing Address - Fax:
Practice Address - Street 1:700 VILLAGE CENTER DR STE 140
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-3020
Practice Address - Country:US
Practice Address - Phone:651-490-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115481223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty