Provider Demographics
NPI:1528128436
Name:HENSELER, STEVEN JOHN
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:HENSELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RADIO DR STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8444
Mailing Address - Country:US
Mailing Address - Phone:651-739-1555
Mailing Address - Fax:651-739-1556
Practice Address - Street 1:1000 RADIO DR STE 220
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8444
Practice Address - Country:US
Practice Address - Phone:651-739-1555
Practice Address - Fax:651-739-1556
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics