Provider Demographics
NPI:1134298839
Name:DIEKMANN, DEBORAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:DIEKMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:PRYOR-DIEKMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1320 TILLER LN
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3770
Mailing Address - Country:US
Mailing Address - Phone:651-639-8637
Mailing Address - Fax:
Practice Address - Street 1:277 3RD ST N
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:MN
Practice Address - Zip Code:55003-1028
Practice Address - Country:US
Practice Address - Phone:651-439-2352
Practice Address - Fax:651-439-3265
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN102461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice