Provider Demographics
NPI:1881770782
Name:DURYEA, DEBRA ANN
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:DURYEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AESTHETIC
Other - Middle Name:IMAGE
Other - Last Name:DENTISTRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:19 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1503
Mailing Address - Country:US
Mailing Address - Phone:973-543-2232
Mailing Address - Fax:973-226-9229
Practice Address - Street 1:19 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1503
Practice Address - Country:US
Practice Address - Phone:973-543-2232
Practice Address - Fax:973-226-9229
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO1770400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist