Provider Demographics
NPI:1932285632
Name:DEBBIE ROUBAL DDS, PC
Entity Type:Organization
Organization Name:DEBBIE ROUBAL DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUBAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-636-1933
Mailing Address - Street 1:1819 N CIRCLE DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2430
Mailing Address - Country:US
Mailing Address - Phone:719-636-1933
Mailing Address - Fax:719-520-0063
Practice Address - Street 1:1819 N CIRCLE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2430
Practice Address - Country:US
Practice Address - Phone:719-636-1933
Practice Address - Fax:719-520-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN 8984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO664974OtherUNITED CONCORDIA