Healthcare Provider Details

I. General information

NPI: 1689515462
Provider Name (Legal Business Name): PAIGE HOFSTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 MAIN ST S
HECTOR MN
55342-1245
US

IV. Provider business mailing address

1550 DEERFIELD RD
WACONIA MN
55387-9736
US

V. Phone/Fax

Practice location:
  • Phone: 320-344-5909
  • Fax:
Mailing address:
  • Phone: 602-830-8294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD15508
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: