Provider Demographics
NPI:1013368877
Name:HEDSTROM, BRIEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIEN
Middle Name:
Last Name:HEDSTROM
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 1:4461 SHERIDAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3513
Mailing Address - Country:US
Mailing Address - Phone:877-328-4785
Mailing Address - Fax:
Practice Address - Street 1:4461 SHERIDAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3513
Practice Address - Country:US
Practice Address - Phone:877-328-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 219661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice