Provider Demographics
NPI:1528194677
Name:FUNG, DEBORAH L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:FUNG
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 1:2860 SNELLING AVE N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1438
Mailing Address - Country:US
Mailing Address - Phone:651-636-2143
Mailing Address - Fax:651-636-5545
Practice Address - Street 1:2860 SNELLING AVE N
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1438
Practice Address - Country:US
Practice Address - Phone:651-636-2143
Practice Address - Fax:651-636-5545
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice