Provider Demographics
NPI:1063683399
Name:DEMBACK, DENISE DONNA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:DONNA
Last Name:DEMBACK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 YORK RD STE 109
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2275
Mailing Address - Country:US
Mailing Address - Phone:410-337-9293
Mailing Address - Fax:
Practice Address - Street 1:2300 YORK RD STE 109
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2275
Practice Address - Country:US
Practice Address - Phone:410-337-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist