Provider Demographics
NPI:1407872823
Name:EATON, DEBRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:EATON
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 1:1627 S. 2ND ST.
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018
Mailing Address - Country:US
Mailing Address - Phone:405-224-6581
Mailing Address - Fax:405-224-3292
Practice Address - Street 1:1627 S. 2ND ST.
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018
Practice Address - Country:US
Practice Address - Phone:405-224-6581
Practice Address - Fax:405-224-3292
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice