Provider Demographics
NPI:1942798426
Name:YOCUM, DEBORA ANNE
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:ANNE
Last Name:YOCUM
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 1:62 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TURBOTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17772-8563
Mailing Address - Country:US
Mailing Address - Phone:570-412-2458
Mailing Address - Fax:
Practice Address - Street 1:62 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TURBOTVILLE
Practice Address - State:PA
Practice Address - Zip Code:17772-8563
Practice Address - Country:US
Practice Address - Phone:570-412-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH006856L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty