Provider Demographics
NPI:1134658255
Name:BECERRA, DEBORAH M (RDH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:BECERRA
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 1:2320 BROADLEAF LOOP
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3620
Mailing Address - Country:US
Mailing Address - Phone:719-237-6548
Mailing Address - Fax:
Practice Address - Street 1:850 W HAPPY CANYON RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3908
Practice Address - Country:US
Practice Address - Phone:303-688-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905225124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO905225OtherDENTAL HYGIENIST LICENSE