Provider Demographics
NPI:1609082346
Name:HEDSTROM, THOMAS LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:HEDSTROM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W BOYLSTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1265
Mailing Address - Country:US
Mailing Address - Phone:508-852-1900
Mailing Address - Fax:508-852-8777
Practice Address - Street 1:1 W BOYLSTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1265
Practice Address - Country:US
Practice Address - Phone:508-852-1900
Practice Address - Fax:508-852-8777
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice