Provider Demographics
NPI:1831681915
Name:IRENE, DEVIN CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:CHARLES
Last Name:IRENE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARK RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-2613
Mailing Address - Country:US
Mailing Address - Phone:307-789-5608
Mailing Address - Fax:
Practice Address - Street 1:650 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:WY
Practice Address - Zip Code:82939
Practice Address - Country:US
Practice Address - Phone:307-782-3630
Practice Address - Fax:307-782-3632
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10830741-9922122300000X
WY1497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist