Provider Demographics
NPI:1780257212
Name:DICKINSEN, EMILY RAE (DT)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:RAE
Last Name:DICKINSEN
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14393 HWY 13 S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2153
Mailing Address - Country:US
Mailing Address - Phone:952-440-2292
Mailing Address - Fax:952-440-2935
Practice Address - Street 1:14393 HWY 13 S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2153
Practice Address - Country:US
Practice Address - Phone:952-440-2292
Practice Address - Fax:952-440-2935
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT140125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist