Provider Demographics
NPI:1184036048
Name:DRIESSEN, STEPHANIE ANNE O'BRIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE O'BRIEN
Last Name:DRIESSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-0649
Mailing Address - Country:US
Mailing Address - Phone:320-968-7062
Mailing Address - Fax:
Practice Address - Street 1:311 DEWEY ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8447
Practice Address - Country:US
Practice Address - Phone:320-968-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist