Provider Demographics
NPI:1912235557
Name:GLIDDEN, DEBORAH KAY
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAY
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEBBIE
Other - Middle Name:K
Other - Last Name:GLIDDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5905 SW TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1261
Mailing Address - Country:US
Mailing Address - Phone:503-245-4707
Mailing Address - Fax:
Practice Address - Street 1:4855 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3460
Practice Address - Country:US
Practice Address - Phone:503-626-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant