Provider Demographics
NPI:1811389851
Name:DEVEAUX, JOSEPH (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DEVEAUX
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48320 VANDERBERG CT
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9466
Mailing Address - Country:US
Mailing Address - Phone:907-252-1774
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD # 5B13
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:907-283-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA588124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist