Healthcare Provider Details

I. General information

NPI: 1720820558
Provider Name (Legal Business Name): HAYDEN SCOTT VANDENBERG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 DOCTORS DR
BOONE NC
28607-5000
US

IV. Provider business mailing address

PO BOX 1490
BOONE NC
28607-1490
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-4651
  • Fax: 828-386-1773
Mailing address:
  • Phone: 828-262-3886
  • Fax: 833-665-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13895
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: