Provider Demographics
NPI:1073355855
Name:DEFFENBAUGH, ABBEY ELIZABETH (DDS)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:ELIZABETH
Last Name:DEFFENBAUGH
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 1:613 FOUNDERS PARK DR W
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-4135
Mailing Address - Country:US
Mailing Address - Phone:205-427-3279
Mailing Address - Fax:
Practice Address - Street 1:115 FOREST RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2410
Practice Address - Country:US
Practice Address - Phone:205-491-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007338-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist