Provider Demographics
NPI:1396144002
Name:DOODY, DEBRA ANN (IPH)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:DOODY
Suffix:
Gender:F
Credentials:IPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 UPPER MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937
Mailing Address - Country:US
Mailing Address - Phone:207-453-6171
Mailing Address - Fax:207-453-6171
Practice Address - Street 1:294 RT 201 - SKOWHEGON ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937
Practice Address - Country:US
Practice Address - Phone:207-453-6171
Practice Address - Fax:207-453-6171
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEIPH50124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist