| NPI | 1790862332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK P DEVEREUX Owner/Orthodontist 985-641-1115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 3676) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 2971) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-02-28 |