1215275425 NPI number — DR. JOCELYN BEVILLE DEFOE D.D.S.

Table of content: DR. JOCELYN BEVILLE DEFOE D.D.S. (NPI 1215275425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215275425 NPI number — DR. JOCELYN BEVILLE DEFOE D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEFOE
Provider First Name:
JOCELYN
Provider Middle Name:
BEVILLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEVILLE
Provider Other First Name:
JOCELYN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215275425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14333 LAUREL BOWIE RD
Provider Second Line Business Mailing Address:
STE. 201
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20708-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-776-3066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14333 LAUREL BOWIE RD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20708-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-775-3066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2013

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: 1223X0400X , with the licence number:  14986 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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