Provider Demographics
NPI:1053889956
Name:DEBORA RAYHAN D.D.S., INC.
Entity type:Organization
Organization Name:DEBORA RAYHAN D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-462-8719
Mailing Address - Street 1:1252 AIRPORT PARK BLVD STE D1
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5979
Mailing Address - Country:US
Mailing Address - Phone:707-462-8719
Mailing Address - Fax:707-472-0921
Practice Address - Street 1:1252 AIRPORT PARK BLVD STE D1
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5979
Practice Address - Country:US
Practice Address - Phone:707-462-8719
Practice Address - Fax:707-472-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty