Provider Demographics
NPI:1255485470
Name:SHEWBRIDGE, DEBORAH KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:KAY
Last Name:SHEWBRIDGE
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 1:116 W WASHINGTON ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-1543
Mailing Address - Country:US
Mailing Address - Phone:304-725-7613
Mailing Address - Fax:
Practice Address - Street 1:116 W WASHINGTON ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1543
Practice Address - Country:US
Practice Address - Phone:304-725-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist