Provider Demographics
NPI:1639911654
Name:DENEVILLE, CADETTE LANCY (DDS)
Entity type:Individual
Prefix:DR
First Name:CADETTE
Middle Name:LANCY
Last Name:DENEVILLE
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 1:501 RISON ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2426
Mailing Address - Country:US
Mailing Address - Phone:786-488-0428
Mailing Address - Fax:
Practice Address - Street 1:501 RISON ST STE 110
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2426
Practice Address - Country:US
Practice Address - Phone:786-488-0428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401419013OtherVA LICENSE NUMBER