Provider Demographics
NPI:1023190311
Name:WEST, DEBRA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SUSAN
Last Name:WEST
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 1:1111 N 102ND CT STE 202
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2194
Mailing Address - Country:US
Mailing Address - Phone:402-393-6400
Mailing Address - Fax:402-393-6401
Practice Address - Street 1:1111 N 102ND CT STE 202
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2194
Practice Address - Country:US
Practice Address - Phone:402-393-6400
Practice Address - Fax:402-393-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE58361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076255100Medicaid