Provider Demographics
NPI:1376593772
Name:AMUNDSON, DEBBIE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:L
Last Name:AMUNDSON
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 1:2775 WINNETKA AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2830
Mailing Address - Country:US
Mailing Address - Phone:763-545-3010
Mailing Address - Fax:763-595-0543
Practice Address - Street 1:2775 WINNETKA AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2830
Practice Address - Country:US
Practice Address - Phone:763-545-3010
Practice Address - Fax:763-595-0543
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice