Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901019107 | MI |
N | 1223G0001X | General Practice | 2901019107 | MI |
N | 213EG0000X | General Practice | 2901019107 | MI |
Y | 1223P0221X | Pediatric Dentist | 24801 | TX |
NPI | 1003019290 |
---|---|
Provider Name | Eric S Devries |
First Address | Amarillo, TX 79109-1852 |
Second Address | Amarillo, TX 79109-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 25/01/2011 |