Individual
DR. JACK P DEVEREUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
2330 GAUSE BLVD E, SLIDELL, LA 70461-4141
(985) 641-1115
(985) 641-8589
Mailing address
2330 E. GAUSE BLVD., SLIDELL, LA 70461-4141
(985) 641-1115
(985) 641-8589
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
2971
MS
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3676
LA
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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