1598882045 NPI number — DR. THOMAS DEVLIN DDS

Table of content: DR. THOMAS DEVLIN DDS (NPI 1598882045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598882045 NPI number — DR. THOMAS DEVLIN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVLIN
Provider First Name:
THOMAS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1598882045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1339 N SUMTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34286-8072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-876-4023
Provider Business Mailing Address Fax Number:
941-876-4369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1339 N SUMTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34286-8072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-876-4023
Provider Business Practice Location Address Fax Number:
941-876-4369
Provider Enumeration Date:
03/22/2007

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: 122300000X , with the licence number:  019026639 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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