Provider Demographics
NPI:1588791651
Name:DAHLEN, DANA F (DMD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:F
Last Name:DAHLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342
Mailing Address - Country:US
Mailing Address - Phone:502-839-3424
Mailing Address - Fax:
Practice Address - Street 1:311 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342
Practice Address - Country:US
Practice Address - Phone:502-839-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43281223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice