Provider Demographics
NPI:1881653129
Name:CLEVELAND, DEBORAH BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:BRUCE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROCK SPRING RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3007
Mailing Address - Country:US
Mailing Address - Phone:973-669-0535
Mailing Address - Fax:973-325-3493
Practice Address - Street 1:110 BERGEN STREET
Practice Address - Street 2:NJDS, D860
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07101-1709
Practice Address - Country:US
Practice Address - Phone:973-972-2453
Practice Address - Fax:973-972-3164
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021095001223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ047765Medicare ID - Type Unspecified
NJU21041Medicare UPIN