Provider Demographics
NPI:1285847806
Name:RALSTON-PAK, DEBORA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:LYNN
Last Name:RALSTON-PAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DEBBI
Other - Middle Name:L
Other - Last Name:RALSTON-PAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6501 E GREENWAY PKWY
Mailing Address - Street 2:BLDG 6, SUITE 161
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2065
Mailing Address - Country:US
Mailing Address - Phone:480-922-0336
Mailing Address - Fax:480-922-8992
Practice Address - Street 1:6501 E GREENWAY PKWY
Practice Address - Street 2:BLDG 6, SUITE 161
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2065
Practice Address - Country:US
Practice Address - Phone:480-922-0336
Practice Address - Fax:480-922-8992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice