1134154974 NPI number — DR. WILLIAM J DEVANEY D.M.D.

Table of content: DR. WILLIAM J DEVANEY D.M.D. (NPI 1134154974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134154974 NPI number — DR. WILLIAM J DEVANEY D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVANEY
Provider First Name:
WILLIAM
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134154974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 LAFAYETTE RD BLDG C
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-5465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-436-7603
Provider Business Mailing Address Fax Number:
603-436-3477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 LAFAYETTE RD BLDG C
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-5465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-436-7603
Provider Business Practice Location Address Fax Number:
603-436-3477
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2515 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30007657 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DEVA194664 . This is a "FEDERAL BC/BS (FEP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 888611 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZE0801 . This is a "MA BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".