Provider Demographics
NPI:1578879532
Name:HOSTETLER, KELSEY MARIE PATTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:MARIE PATTON
Last Name:HOSTETLER
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 1:271 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1470
Mailing Address - Country:US
Mailing Address - Phone:608-845-6612
Mailing Address - Fax:
Practice Address - Street 1:271 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1470
Practice Address - Country:US
Practice Address - Phone:608-845-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7161122300000X
MI2901020299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist