Provider Demographics
NPI:1801966494
Name:TEDDER, DIANA STERLING (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:STERLING
Last Name:TEDDER
Suffix:
Gender:F
Credentials:DMD
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 699
Mailing Address - Street 2:5651 HIGHWAY 43 SATSUMA FAMILY DENTAL
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572
Mailing Address - Country:US
Mailing Address - Phone:251-679-9428
Mailing Address - Fax:251-679-9180
Practice Address - Street 1:5651 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:AL
Practice Address - Zip Code:36572
Practice Address - Country:US
Practice Address - Phone:251-679-9428
Practice Address - Fax:251-679-9180
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice