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General NPI Number Information
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NPI Number | 1649589441
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Entity Type | Organization
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Legal Business Name | HAYDEN FAMILY DENTAL CENTER, PLLC
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 52 W COMMERCE DR
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City | HAYDEN
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State | ID
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Zip | 83835-9221
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Country | US
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Telephone | 208-772-3132
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Fax | 208-772-9742
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | HAYDEN
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State | ID
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Zip | 83835-0007
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Country | US
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Telephone | 208-772-3132
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Fax | 208-772-9742
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BENJAMIN D BABCOCK
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Credential | DDS
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Telephone | 208-772-3132
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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 | D2001
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License Number State | ID
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