1447364328 NPI number — DR. ABBY MARIE DEBONIS DDS

Table of content: DR. ABBY MARIE DEBONIS DDS (NPI 1447364328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447364328 NPI number — DR. ABBY MARIE DEBONIS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEBONIS
Provider First Name:
ABBY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447364328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4341 TUDOR CENTRE DR 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-729-5157
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 GAFFNEY ROAD #7500
Provider Second Line Business Practice Location Address:
USA DENTAC
Provider Business Practice Location Address City Name:
FORT WAINWRIGHT
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-361-5530
Provider Business Practice Location Address Fax Number:
907-361-4859
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6031-015 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)