Provider Demographics
NPI:1902937311
Name:MEADOWS, DEBRA A (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:MEADOWS
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 1:1334 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6949
Mailing Address - Country:US
Mailing Address - Phone:909-798-8885
Mailing Address - Fax:
Practice Address - Street 1:2015B N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4834
Practice Address - Country:US
Practice Address - Phone:909-886-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics