Provider Demographics
NPI:1710066279
Name:HEDSTROM KAUFMANN, STEPHENIE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHENIE
Middle Name:L
Last Name:HEDSTROM KAUFMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHENIE
Other - Middle Name:H
Other - Last Name:KAUFMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-6069
Mailing Address - Country:US
Mailing Address - Phone:719-687-4033
Mailing Address - Fax:
Practice Address - Street 1:400 W MIDLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3196
Practice Address - Country:US
Practice Address - Phone:719-687-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist