Individual
LYDIA J DIEKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADT
Contact information
Practice address
2711 BROADWAY AVE STE A00, SLAYTON, MN 56172-1313
(507) 836-1000
(507) 836-1008
Mailing address
2711 BROADWAY AVE STE A00, SLAYTON, MN 56172-1313
(507) 836-1000
(507) 836-1008
Taxonomy
Speciality
Code
Description
License number
State
125K00000X
Advanced Practice Dental Therapist
Primary
DT37
MN
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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