Provider Demographics
NPI:1356757595
Name:DEVORE, CASEY LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:LEIGH
Last Name:DEVORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 WESTCHESTER DR
Mailing Address - Street 2:APT #8
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2149
Mailing Address - Country:US
Mailing Address - Phone:785-341-3453
Mailing Address - Fax:
Practice Address - Street 1:1640 CHARLES PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-0428
Practice Address - Country:US
Practice Address - Phone:785-537-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS609891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice