Provider Demographics
NPI:1306975339
Name:DEVOLL, ROBERT E (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:DEVOLL
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TEXAS AVE
Mailing Address - Street 2:STE D
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-338-1760
Mailing Address - Fax:281-332-6425
Practice Address - Street 1:450 TEXAS AVE
Practice Address - Street 2:STE D
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-338-1760
Practice Address - Fax:281-332-6425
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist