Provider Demographics
NPI:1134154974
Name:DEVANEY, WILLIAM J (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:DEVANEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LAFAYETTE RD BLDG C
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5465
Mailing Address - Country:US
Mailing Address - Phone:603-436-7603
Mailing Address - Fax:603-436-3477
Practice Address - Street 1:230 LAFAYETTE RD BLDG C
Practice Address - Street 2:SUITE 2
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5465
Practice Address - Country:US
Practice Address - Phone:603-436-7603
Practice Address - Fax:603-436-3477
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007657Medicaid
DEVA194664OtherFEDERAL BC/BS (FEP)
888611OtherUNITED CONCORDIA
MAZE0801OtherMA BLUE CROSS BLUE SHIELD