Provider Demographics
NPI:1639384563
Name:HEDSTROM, J. JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:JOSEPH
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 1:360 ROUTE 101
Mailing Address - Street 2:UNIT 12A
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5030
Mailing Address - Country:US
Mailing Address - Phone:603-472-3667
Mailing Address - Fax:603-472-4758
Practice Address - Street 1:360 ROUTE 101
Practice Address - Street 2:UNIT 12A
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5030
Practice Address - Country:US
Practice Address - Phone:603-472-3667
Practice Address - Fax:603-472-4758
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice