Provider Demographics
NPI:1780693606
Name:DEVINE, BILL P
Entity type:Individual
Prefix:DR
First Name:BILL
Middle Name:P
Last Name:DEVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:P
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2743 FERDINAND
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054
Mailing Address - Country:US
Mailing Address - Phone:817-477-2201
Mailing Address - Fax:
Practice Address - Street 1:2743 FERDINAND
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:76054
Practice Address - Country:US
Practice Address - Phone:817-477-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice