Provider Demographics
NPI:1508964792
Name:SHIBA, DEBORAH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:SHIBA
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 1:2025 FOREST AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4806
Mailing Address - Country:US
Mailing Address - Phone:408-286-2030
Mailing Address - Fax:408-287-0950
Practice Address - Street 1:2025 FOREST AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4806
Practice Address - Country:US
Practice Address - Phone:408-286-2030
Practice Address - Fax:408-287-0950
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist