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General NPI Number Information
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NPI Number | 1841938776
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Entity Type | Individual
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Provider Name | HAYDEN KEVIN SHARP DDS
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Gender | Male
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Dates
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Enumeration Date | 05/20/2022
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 7093 E SUPER 1 LOOP
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City | ATHOL
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State | ID
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Zip | 83854
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Country | US
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Telephone | 208-561-9013
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Fax | 208-561-9014
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Provider Business Mailing Address
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Address Line | PO BOX 1386
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City | HAYDEN
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State | ID
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Zip | 83835-1386
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5441
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License Number State | ID
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