Provider Demographics
NPI:1215275425
Name:DEFOE, JOCELYN BEVILLE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:BEVILLE
Last Name:DEFOE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOCELYN
Other - Middle Name:MICHELLE
Other - Last Name:BEVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14333 LAUREL BOWIE RD
Mailing Address - Street 2:STE. 201
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1126
Mailing Address - Country:US
Mailing Address - Phone:301-776-3066
Mailing Address - Fax:
Practice Address - Street 1:14333 LAUREL BOWIE RD
Practice Address - Street 2:STE 201
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1126
Practice Address - Country:US
Practice Address - Phone:301-775-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics