Provider Demographics
NPI:1215947692
Name:EISEN, DEBBIE SUSAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:SUSAN
Last Name:EISEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HOME ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3248
Mailing Address - Country:US
Mailing Address - Phone:781-322-5952
Mailing Address - Fax:781-324-6990
Practice Address - Street 1:440 HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2574
Practice Address - Country:US
Practice Address - Phone:781-598-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice