Provider Demographics
NPI:1750501391
Name:DAHLBERG, DEANNA L (RDA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:DAHLBERG
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 991793
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1793
Mailing Address - Country:US
Mailing Address - Phone:530-242-1108
Mailing Address - Fax:
Practice Address - Street 1:1425 VICTOR AVE STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4035
Practice Address - Country:US
Practice Address - Phone:530-242-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21338124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist