Provider Demographics
NPI:1548708423
Name:DEBRA A. MEADOWS, DDS INC
Entity type:Organization
Organization Name:DEBRA A. MEADOWS, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PASIUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-383-8931
Mailing Address - Street 1:1881 BUSINESS CENTER DRIVE
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:909-383-8931
Mailing Address - Fax:909-383-0516
Practice Address - Street 1:1881 BUSINESS CENTER DRIVE
Practice Address - Street 2:SUITE 7A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3465
Practice Address - Country:US
Practice Address - Phone:909-383-8931
Practice Address - Fax:909-383-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty