Provider Demographics
NPI:1639459589
Name:HOFSTETTER, COLLEEN TEPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:TEPE
Last Name:HOFSTETTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:ELISE
Other - Last Name:TEPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3507 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5457
Mailing Address - Country:US
Mailing Address - Phone:513-481-5885
Mailing Address - Fax:513-481-4270
Practice Address - Street 1:3507 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5457
Practice Address - Country:US
Practice Address - Phone:513-481-5885
Practice Address - Fax:513-481-4270
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300234981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice