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General NPI Number Information
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NPI Number | 1295951606
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Entity Type | Organization
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Legal Business Name | KENNETH C HYTEN & DAVID W HYTEN LTD
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2110 TROY RD SUITE A
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-2549
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Country | US
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Telephone | 618-656-1914
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Fax | 618-656-2053
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Provider Business Mailing Address
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Address Line | 2110 TROY RD SUITE A
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-2549
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Country | US
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Telephone | 618-656-1914
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Fax | 618-656-2053
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID WILLIAM HYTEN
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Credential | DMD
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Telephone | 618-656-1914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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