Provider Demographics
NPI:1124655980
Name:DEVENS, PRESTON RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:RICHARD
Last Name:DEVENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 CENTRE AVE APT 809
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1316
Mailing Address - Country:US
Mailing Address - Phone:610-675-6680
Mailing Address - Fax:
Practice Address - Street 1:351 LOUCKS RD STE E4
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1740
Practice Address - Country:US
Practice Address - Phone:717-848-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice