Organization
DEVEREUX AND NGUYEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK P DEVEREUX D.D.S., M.S. (OWNER AND ORTHODONTIST)
(601) 799-3120
Entity
Organization
Contact information
Practice address
6420 HIGHWAY 11, SUITE C, CARRIERE, MS 39426-7145
(601) 799-3120
(601) 251-0006
Mailing address
6420 HIGHWAY 11, SUITE C, CARRIERE, MS 39426-7145
(601) 799-3120
(601) 251-0006
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2971
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04183242
—
MS
Enumeration date
05/03/2007
Last updated
02/28/2013
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