Provider Demographics
NPI:1194897603
Name:PRIESTAP, DEBORAH ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:PRIESTAP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:745 N MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1536
Mailing Address - Country:US
Mailing Address - Phone:248-684-6833
Mailing Address - Fax:248-684-4713
Practice Address - Street 1:745 N MILFORD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1536
Practice Address - Country:US
Practice Address - Phone:248-684-6833
Practice Address - Fax:248-684-4713
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010138611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics