Provider Demographics
NPI:1134433865
Name:GIRON, DEVIN KYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:KYLE
Last Name:GIRON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEVIN
Other - Middle Name:KYLE
Other - Last Name:GIRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:P.O BOX 640
Mailing Address - Street 2:
Mailing Address - City:ISLETA
Mailing Address - State:NM
Mailing Address - Zip Code:87022-0640
Mailing Address - Country:US
Mailing Address - Phone:505-869-3200
Mailing Address - Fax:505-869-4881
Practice Address - Street 1:01 SAGEBRUSH STREET
Practice Address - Street 2:
Practice Address - City:ISLETA
Practice Address - State:NM
Practice Address - Zip Code:87022-0640
Practice Address - Country:US
Practice Address - Phone:506-869-3200
Practice Address - Fax:505-869-4881
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD33141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95886061Medicaid