Provider Demographics
NPI:1548513518
Name:HORNSTRA, ZONA LYN (RDH)
Entity type:Individual
Prefix:MRS
First Name:ZONA
Middle Name:LYN
Last Name:HORNSTRA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 E. 37TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-0000
Mailing Address - Country:US
Mailing Address - Phone:605-371-9667
Mailing Address - Fax:
Practice Address - Street 1:4420 E 37TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-6556
Practice Address - Country:US
Practice Address - Phone:605-371-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDH596124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist