Provider Demographics
NPI:1861583809
Name:DEVENING, DONALD CLAYTON JR (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:CLAYTON
Last Name:DEVENING
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HOUSTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2414
Mailing Address - Country:US
Mailing Address - Phone:540-463-2134
Mailing Address - Fax:540-464-9660
Practice Address - Street 1:112 HOUSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2414
Practice Address - Country:US
Practice Address - Phone:540-463-2134
Practice Address - Fax:540-464-9660
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010048301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA074717OtherANTHEM BCBS