Provider Demographics
NPI:1396806311
Name:DEVEAUX, ERROL (DDS)
Entity type:Individual
Prefix:
First Name:ERROL
Middle Name:
Last Name:DEVEAUX
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 1:591 YATES DR
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2966
Mailing Address - Country:US
Mailing Address - Phone:270-300-4706
Mailing Address - Fax:
Practice Address - Street 1:309 N WILSON RD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2194
Practice Address - Country:US
Practice Address - Phone:270-352-4343
Practice Address - Fax:270-352-2323
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice