Provider Demographics
NPI:1770859241
Name:DEBI M HUYSSOON DMD PC
Entity Type:Organization
Organization Name:DEBI M HUYSSOON DMD PC
Other - Org Name:SHERWOOD OLD TOWN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUYSSOON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-625-6221
Mailing Address - Street 1:16043 SW RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16043 SW RAILROAD ST
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9340
Practice Address - Country:US
Practice Address - Phone:503-625-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty