Phillip Russell Devore, D.D.S.
Individual provider Active NPI General Practice Dentistry · Las Vegas, NV
NPI 1992765366 · NPPES record last updated Feb 5, 2015
Key facts
- NPI
- 1992765366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4285 (NV)
- Practice address
- 1700 W Charleston BLDG D
Las Vegas, NV 89102 - Phone
- (702) 774-8000
- Fax
- (702) 774-2812
- NPI assigned
- Mar 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150217000363 | NV | Order and Referring Only - Oral Surgery |
5799000626 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4285 | NV | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Board of Regents, Nevada System of Higher Education | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4285 | NV | Yes |
Addresses
Primary practice location
1700 W Charleston BLDG D
Las Vegas, NV 89102
Mailing address
1001 Shadow Lane Ms 7413
Las Vegas, NV 89106
Phone (702) 774-8000
Other providers in Las Vegas, NV
- Devonee'S Heart & Soul Healthcare LLC
- Kathline Devor
- Piedad Devor
- Brittany Alysa Devora
- Brittney Renee Devore
- Renee Devoure
- Britley China Devoux
- Seetiana Carolina Devoux
- Josh Devries
- Rahul Devroy
All providers in Las Vegas, NV · General Practice Dentistry in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.