Provider Demographics
NPI:1790088979
Name:DEGNER, CYNTHIA ANN (DENTAL THERAPIST/RDH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:DEGNER
Suffix:
Gender:F
Credentials:DENTAL THERAPIST/RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DREW AVE SE STE 202
Mailing Address - Street 2:
Mailing Address - City:MADELIA
Mailing Address - State:MN
Mailing Address - Zip Code:56062-1870
Mailing Address - Country:US
Mailing Address - Phone:507-588-5011
Mailing Address - Fax:
Practice Address - Street 1:115 DREW AVE SE STE 202
Practice Address - Street 2:
Practice Address - City:MADELIA
Practice Address - State:MN
Practice Address - Zip Code:56062-1870
Practice Address - Country:US
Practice Address - Phone:507-588-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8546124Q00000X
MNDT155125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist