Provider Demographics
NPI:1306871470
Name:KEARNEY, DEBORAH L (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:KEARNEY
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 1:645 BREVARD AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7807
Mailing Address - Country:US
Mailing Address - Phone:321-635-8533
Mailing Address - Fax:321-635-8321
Practice Address - Street 1:645 BREVARD AVE
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7807
Practice Address - Country:US
Practice Address - Phone:321-635-8533
Practice Address - Fax:321-635-8321
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice