Provider Demographics
NPI:1508015520
Name:DIERKING, ABIGAIL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:ANN
Last Name:DIERKING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ABIGAIL
Other - Middle Name:ANN
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7231 MEADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3780
Mailing Address - Country:US
Mailing Address - Phone:317-361-6493
Mailing Address - Fax:
Practice Address - Street 1:3002 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3020
Practice Address - Country:US
Practice Address - Phone:502-451-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019890122300000X
IN12011203A122300000X
KY10375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315037627OtherLICENSE