Provider Demographics
NPI:1619925427
Name:MARYNAK, DEBORAH LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:MARYNAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:MARYNAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1201 NE 7TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-474-4360
Mailing Address - Fax:541-474-0685
Practice Address - Street 1:1201 NE 7TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-474-4360
Practice Address - Fax:541-474-0685
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9656122300000X
ORD9570122300000X
OR9570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist