Healthcare Provider Details

I. General information

NPI: 1982770863
Provider Name (Legal Business Name): STEVEN E HOFSTAD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W NORTHERN LIGHTS SUITE 1
ANCH AK
99503
US

IV. Provider business mailing address

400 W NORTHERN LIGHTS BOULEVARD SUITE 1
ANCH AK
99503
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-4082
  • Fax: 907-562-9165
Mailing address:
  • Phone: 907-561-4082
  • Fax: 907-562-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number704
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000704
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: