Provider Demographics
NPI:1467665505
Name:DEVEREUX AND NGUYEN LLC
Entity type:Organization
Organization Name:DEVEREUX AND NGUYEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEVEREUX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:504-368-7513
Mailing Address - Street 1:2800 MANHATTAN BLVD.
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2904
Mailing Address - Country:US
Mailing Address - Phone:504-368-7513
Mailing Address - Fax:504-368-3932
Practice Address - Street 1:2800 MANHATTAN BLVD.
Practice Address - Street 2:SUITE D
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2904
Practice Address - Country:US
Practice Address - Phone:504-368-7513
Practice Address - Fax:504-368-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57141223S0112X
LA36761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty