Provider Demographics
NPI:1730512245
Name:ULRICKSON, DIANA N (DDS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:N
Last Name:ULRICKSON
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 1:801 ENCINO PL NE STE A3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2639
Mailing Address - Country:US
Mailing Address - Phone:505-232-3588
Mailing Address - Fax:505-232-3593
Practice Address - Street 1:801 ENCINO PL NE STE A3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2639
Practice Address - Country:US
Practice Address - Phone:505-232-3588
Practice Address - Fax:505-232-3593
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD37161223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics