Provider Demographics
NPI:1447260815
Name:DEVIESE, DAVID MYERS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MYERS
Last Name:DEVIESE
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:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:VA
Mailing Address - Zip Code:22727-0304
Mailing Address - Country:US
Mailing Address - Phone:540-948-4488
Mailing Address - Fax:540-948-4662
Practice Address - Street 1:306 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-3026
Practice Address - Country:US
Practice Address - Phone:540-948-4488
Practice Address - Fax:540-948-4662
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010044011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice