Provider Demographics
NPI:1972732311
Name:DIEKMAN, STEVEN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:DIEKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 14TH AVENUE EAST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3363
Mailing Address - Country:US
Mailing Address - Phone:701-281-1937
Mailing Address - Fax:
Practice Address - Street 1:1042 14TH AVENUE EAST
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3363
Practice Address - Country:US
Practice Address - Phone:701-281-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1656122300000X
MN8995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist