Provider Demographics
NPI:1790020543
Name:HOUSLEY, DEBORAH SUSAN
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:SUSAN
Last Name:HOUSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DOTEN LN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-5605
Mailing Address - Country:US
Mailing Address - Phone:207-890-6974
Mailing Address - Fax:
Practice Address - Street 1:9 DOTEN LN
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-5605
Practice Address - Country:US
Practice Address - Phone:207-890-6974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2741124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist