Provider Demographics
NPI:1740416700
Name:DUVERNEY, LORETTA MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:MICHELLE
Last Name:DUVERNEY
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 1:3401 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2501
Mailing Address - Country:US
Mailing Address - Phone:202-829-5437
Mailing Address - Fax:202-829-9255
Practice Address - Street 1:201 W 8TH ST
Practice Address - Street 2:SUITE 810
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3038
Practice Address - Country:US
Practice Address - Phone:719-562-4468
Practice Address - Fax:719-583-1801
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10005551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice