Provider Demographics
NPI:1043458169
Name:RAYHAN, DEBORA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:
Last Name:RAYHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DEBORA
Other - Middle Name:RAYHAN
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 MISSION CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5372
Mailing Address - Country:US
Mailing Address - Phone:707-538-7600
Mailing Address - Fax:707-538-7696
Practice Address - Street 1:55 MISSION CIR STE 104
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5372
Practice Address - Country:US
Practice Address - Phone:707-538-7600
Practice Address - Fax:707-538-7696
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435541223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics