Provider Demographics
NPI:1841285806
Name:CEDERBAUM, DEBRA L (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:CEDERBAUM
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 1:916 NE RAVENNA BLVD
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5566
Mailing Address - Country:US
Mailing Address - Phone:206-524-1314
Mailing Address - Fax:206-524-3896
Practice Address - Street 1:916 NE RAVENNA BLVD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5566
Practice Address - Country:US
Practice Address - Phone:206-524-1314
Practice Address - Fax:206-524-3896
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice