Provider Demographics
NPI:1184400079
Name:STEDDUM, SARA DAWN THOMAS (RDH)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DAWN THOMAS
Last Name:STEDDUM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DAWN THOMAS
Other - Last Name:FRIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:10975 MATTA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-9628
Mailing Address - Country:US
Mailing Address - Phone:406-471-0122
Mailing Address - Fax:
Practice Address - Street 1:1667 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-RDH-LIC-5934124Q00000X
AZH05213124Q00000X
CODH.002026628124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist