Provider Demographics
NPI:1942437173
Name:DEVEREUX AND NGUYEN LLC
Entity Type:Organization
Organization Name:DEVEREUX AND NGUYEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-641-1115
Mailing Address - Street 1:1905 W THOMAS ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2901
Mailing Address - Country:US
Mailing Address - Phone:985-340-3838
Mailing Address - Fax:985-340-3833
Practice Address - Street 1:1905 W THOMAS ST
Practice Address - Street 2:SUITE M
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2901
Practice Address - Country:US
Practice Address - Phone:985-340-3838
Practice Address - Fax:985-340-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty