Provider Demographics
NPI:1679621320
Name:DONNELL-RANDALL, STEFANIE COLLEEN (DDS)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:COLLEEN
Last Name:DONNELL-RANDALL
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 1:2353 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1109
Mailing Address - Country:US
Mailing Address - Phone:515-248-1470
Mailing Address - Fax:515-248-1473
Practice Address - Street 1:2353 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1109
Practice Address - Country:US
Practice Address - Phone:515-248-1470
Practice Address - Fax:515-248-1473
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist