Provider Demographics
NPI:1780809129
Name:MCNEIL-AMORTEGUY, DEBORAH ANN (DDS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:MCNEIL-AMORTEGUY
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 1:1250 PEACH STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-1324
Mailing Address - Country:US
Mailing Address - Phone:805-543-3016
Mailing Address - Fax:805-543-3444
Practice Address - Street 1:1250 PEACH ST
Practice Address - Street 2:SUITE F
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2837
Practice Address - Country:US
Practice Address - Phone:805-543-3016
Practice Address - Fax:805-543-3444
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist