Provider Demographics
NPI:1073084752
Name:KRAFT, STEPHANIE SUZANNE (DA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:DA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:SUZANNE
Other - Last Name:SHINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1667 COCHRANE CIR BLDG 7495
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1667 COCHRANE CIR BLDG 7495
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant