Provider Demographics
NPI:1144340910
Name:DEVITT, JAZMIN A (DDS)
Entity type:Individual
Prefix:DR
First Name:JAZMIN
Middle Name:A
Last Name:DEVITT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 JEFFERSON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-7119
Mailing Address - Country:US
Mailing Address - Phone:847-635-1100
Mailing Address - Fax:847-635-1162
Practice Address - Street 1:1300 JEFFERSON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-7119
Practice Address - Country:US
Practice Address - Phone:847-635-1100
Practice Address - Fax:847-635-1162
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0229521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice