Provider Demographics
NPI:1780878504
Name:DEVRY, GAYANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:GAYANNE
Middle Name:
Last Name:DEVRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 PARKCREST DR STE 250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4987
Mailing Address - Country:US
Mailing Address - Phone:512-459-4746
Mailing Address - Fax:512-459-4792
Practice Address - Street 1:5608 PARKCREST DR STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4987
Practice Address - Country:US
Practice Address - Phone:512-459-4746
Practice Address - Fax:512-459-4792
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist