Provider Demographics
NPI:1649610536
Name:DALLA, DEVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEVAN
Middle Name:
Last Name:DALLA
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 E PINTAIL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8206
Mailing Address - Country:US
Mailing Address - Phone:646-427-6519
Mailing Address - Fax:
Practice Address - Street 1:2733 ELK GROVE BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7165
Practice Address - Country:US
Practice Address - Phone:916-975-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02540600122300000X
CADDS63130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist