# DEBONAIR INK

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Aesthetic Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194031336
- **Authorized official:** DEBORA KAY MOSHOS RDH (PRESIDENT)
- **Authorized official phone:** (928) 774-1170

## Contact information

- **Practice address:** 1415 N BEAVER ST, FLAGSTAFF, AZ 86001-1401
- **Practice address phone:** (928) 774-1170
- **Practice address fax:** (928) 774-1171
- **Mailing address:** 1415 N BEAVER ST, FLAGSTAFF, AZ 86001-1401
- **Mailing address phone:** (928) 774-1170
- **Mailing address fax:** (928) 774-1171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/25/2010
- **Last updated:** 09/08/2010