Provider Demographics
NPI:1467689067
Name:SCHOTTHOEFER, KRISTEN ANN-ROEHRIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ANN-ROEHRIG
Last Name:SCHOTTHOEFER
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 1:1685 FAIRHOLME RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2368
Mailing Address - Country:US
Mailing Address - Phone:586-873-8904
Mailing Address - Fax:
Practice Address - Street 1:1685 FAIRHOLME RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2368
Practice Address - Country:US
Practice Address - Phone:313-512-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010200361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice