Provider Demographics
NPI:1114154333
Name:CERVERA, DEBRA Q (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:Q
Last Name:CERVERA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 TIERRA BONITA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78263-3932
Mailing Address - Country:US
Mailing Address - Phone:210-648-5837
Mailing Address - Fax:
Practice Address - Street 1:1702 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3435
Practice Address - Country:US
Practice Address - Phone:210-658-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9062124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist