Provider Demographics
NPI:1518914845
Name:DUDENBOSTEL, DEANNA SUE (DMD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:SUE
Last Name:DUDENBOSTEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 REDBUD CT
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2623
Mailing Address - Country:US
Mailing Address - Phone:215-491-8623
Mailing Address - Fax:
Practice Address - Street 1:2621 N BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9401
Practice Address - Country:US
Practice Address - Phone:215-822-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028846L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry