Provider Demographics
NPI:1639241185
Name:SAHULKA, DEBRA SUE (RDH)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:SUE
Last Name:SAHULKA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:SUE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:2112 HARDING CT SW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4125
Mailing Address - Country:US
Mailing Address - Phone:218-335-3230
Mailing Address - Fax:
Practice Address - Street 1:425 7TH ST NW
Practice Address - Street 2:CASS LAKE PHS INDIAN HOSPITAL
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:218-335-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6497124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN887969900Medicare ID - Type Unspecified