Provider Demographics
NPI:1114368859
Name:NIELSEN, STEPHANIE STARIHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:STARIHA
Last Name:NIELSEN
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 1:1525 RIVERSIDE AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4390
Mailing Address - Country:US
Mailing Address - Phone:970-493-9001
Mailing Address - Fax:
Practice Address - Street 1:1525 RIVERSIDE AVE
Practice Address - Street 2:UNIT B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4390
Practice Address - Country:US
Practice Address - Phone:970-493-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist