Healthcare Provider Details

I. General information

NPI: 1932316247
Provider Name (Legal Business Name): DEBORAH JEAN LIEN DDS, MBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 2ND AVENUE NE
BLOOMING PRAIRIE MN
55917
US

IV. Provider business mailing address

4409 ROSSI CT NW
ROCHESTER MN
55901-8653
US

V. Phone/Fax

Practice location:
  • Phone: 507-583-6613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD9546
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD9546
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: