Active NPI
Jack P Devereux, D.D.S., M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Slidell, LA
National Provider Identifier
1376620906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 3676
- Practice address
- 2330 Gause Blvd E
Slidell, LA 70461-4141 - Phone
- (985) 641-1115
- Fax
- (985) 641-8589
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 3676 | LA | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2971 | MS |
Addresses
Primary practice location
2330 Gause Blvd E
Slidell, LA 70461-4141
Mailing address
2330 E. Gause Blvd.
Slidell, LA 70461-4141
Phone (985) 641-1115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3676 | LA | MD | Mental Health Counselor |
| 2971 | MS | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scott V. Law, D.M.D. Louisiana, a Professional Dental Corporation | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
| Devereux and Nguyen LLC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Slidell, LA
- NPI 1790862332
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Harvey, LA
- NPI 1679062574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376620906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2330 E. GAUSE BLVD.",
"city": "SLIDELL",
"state": "LA",
"postal_code": "704614141",
"telephone_number": "985-641-1115",
"fax_number": "985-641-8589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2330 GAUSE BLVD E",
"city": "SLIDELL",
"state": "LA",
"postal_code": "704614141",
"telephone_number": "985-641-1115",
"fax_number": "985-641-8589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVEREUX",
"first_name": "JACK",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "LA",
"license": "3676",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MS",
"license": "2971",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Slidell, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.