Provider Demographics
NPI:1336159227
Name:HELMBRECHT, DIANA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:HELMBRECHT
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 1:114 MINNIE ST
Mailing Address - Street 2:STE C
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-456-4580
Mailing Address - Fax:907-456-4588
Practice Address - Street 1:114 MINNIE ST
Practice Address - Street 2:STE C
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-456-4580
Practice Address - Fax:907-456-4588
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAA642Medicaid