Provider Demographics
NPI:1417248600
Name:STUEDEMANN, KRISTINA (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:STUEDEMANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17519 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4300
Mailing Address - Country:US
Mailing Address - Phone:708-429-2111
Mailing Address - Fax:
Practice Address - Street 1:17519 80TH AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4300
Practice Address - Country:US
Practice Address - Phone:708-429-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice