Provider Demographics
NPI:1336287051
Name:ADAMS, DEBORAH S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:ADAMS
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 1:12 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1804
Mailing Address - Country:US
Mailing Address - Phone:631-751-0538
Mailing Address - Fax:
Practice Address - Street 1:329 E MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2830
Practice Address - Country:US
Practice Address - Phone:631-265-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY359841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice