Provider Demographics
NPI:1760528004
Name:SHERMAN H. DEVEAS III, DDS P.A.
Entity Type:Organization
Organization Name:SHERMAN H. DEVEAS III, DDS P.A.
Other - Org Name:WEST BALTIMORE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-566-2080
Mailing Address - Street 1:3322 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3810
Mailing Address - Country:US
Mailing Address - Phone:410-566-2080
Mailing Address - Fax:410-566-6379
Practice Address - Street 1:3322 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3810
Practice Address - Country:US
Practice Address - Phone:410-566-2080
Practice Address - Fax:410-566-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD877136OtherUNITED CONCORDIA PROVIDER