Provider Demographics
NPI:1194031336
Name:DEBONAIR INK
Entity type:Organization
Organization Name:DEBONAIR INK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MOSHOS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:928-774-1170
Mailing Address - Street 1:1415 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1401
Mailing Address - Country:US
Mailing Address - Phone:928-774-1170
Mailing Address - Fax:928-774-1171
Practice Address - Street 1:1415 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1401
Practice Address - Country:US
Practice Address - Phone:928-774-1170
Practice Address - Fax:928-774-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty