Provider Demographics
NPI:1770663841
Name:DEVERILL, ERIC D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:DEVERILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10531 4S COMMONS DR # 590
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3517
Mailing Address - Country:US
Mailing Address - Phone:858-888-5506
Mailing Address - Fax:858-428-5017
Practice Address - Street 1:437 S HIGHWAY 101 STE 121
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2219
Practice Address - Country:US
Practice Address - Phone:858-794-0231
Practice Address - Fax:858-794-0275
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice