Provider Demographics
NPI:1508832585
Name:VIDONI-HARTUNG, STEPHANIE BETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BETH
Last Name:VIDONI-HARTUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9542 S. PLACITA POTENCIA
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2171
Mailing Address - Country:US
Mailing Address - Phone:520-405-3210
Mailing Address - Fax:520-886-2229
Practice Address - Street 1:6596 N ORACLE RD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-297-9069
Practice Address - Fax:520-515-9600
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ523789Medicaid