Healthcare Provider Details

I. General information

NPI: 1548331986
Provider Name (Legal Business Name): BENJAMIN DEAN BABCOCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W COMMERCE DR
HAYDEN ID
83835
US

IV. Provider business mailing address

PO BOX 7 52 W COMMERCE DR
HAYDEN ID
83835
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-3132
  • Fax: 208-772-9742
Mailing address:
  • Phone: 208-772-3132
  • Fax: 208-772-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD2001
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: