Healthcare Provider Details

I. General information

NPI: 1053889956
Provider Name (Legal Business Name): DEBORA RAYHAN D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 AIRPORT PARK BLVD STE D1
UKIAH CA
95482-5979
US

IV. Provider business mailing address

1252 AIRPORT PARK BLVD STE D1
UKIAH CA
95482-5979
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-8719
  • Fax: 707-472-0921
Mailing address:
  • Phone: 707-462-8719
  • Fax: 707-472-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: TONIA PAYNE
Title or Position: REGIONAL MANAGER
Credential:
Phone: 707-462-8719