Individual
DR. ELLIOT JAMES DEVINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
USA DENTAL ACTIVITY, ATTN: MCDS NA B, BLDG 6837 NORMANDY DRIVE, FORT BRAGG, NC 28310-7302
(910) 643-2196
(910) 396-7017
Mailing address
609 CASSELL DR APT 204, FAYETTEVILLE, NC 28311-1606
(724) 316-9563
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS041295
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS041295
DENTAL LICENSE
PA
Enumeration date
08/17/2017
Last updated
08/17/2017
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