Provider Demographics
NPI:1689754574
Name:NACHMAN, DEBORAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:NACHMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MANGOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:266 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3436
Mailing Address - Country:US
Mailing Address - Phone:201-847-0948
Mailing Address - Fax:201-847-0948
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:201-785-4146
Practice Address - Fax:201-485-7291
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DL01871000122300000X
NJ22DL01871002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6432409Medicaid