Provider Demographics
NPI:1215032248
Name:WORSHAM, DEBRAH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRAH
Middle Name:J
Last Name:WORSHAM
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 1:215 HURST ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-4321
Mailing Address - Country:US
Mailing Address - Phone:936-598-2626
Mailing Address - Fax:936-598-7651
Practice Address - Street 1:215 HURST ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-4321
Practice Address - Country:US
Practice Address - Phone:936-598-2626
Practice Address - Fax:936-598-7651
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14714122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14714OtherLICENSE