Provider Demographics
NPI:1669655866
Name:MCMAHAN, DEBBIE JEAN (RDH)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:JEAN
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 STEELE ST
Mailing Address - Street 2:103
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2548
Mailing Address - Country:US
Mailing Address - Phone:303-321-2745
Mailing Address - Fax:
Practice Address - Street 1:1327 STEELE ST
Practice Address - Street 2:103
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2548
Practice Address - Country:US
Practice Address - Phone:303-321-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO202280124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26438577Medicaid