Individual
TERRY M DEVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
118 JACKSON WALK PLZ, 208, JACKSON, TN 38301-3016
(901) 604-3049
Mailing address
118 JACKSON WALK PLZ, 208, JACKSON, TN 38301-3016
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7852
TN
1223G0001X
General Practice Dentistry
Primary
2285-86
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2285-86
DENTAL LICENSE
MS
01
—
7852
TENNESSEE DENTAL LICENSE NUMBER
TN
Enumeration date
10/11/2007
Last updated
02/10/2017
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