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General NPI Number Information
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NPI Number | 1902211733
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Entity Type | Individual
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Provider Name | THANE HEPWORTH DDS
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Gender | Male
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 3 E CENTER ST
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City | SUGAR CITY
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State | ID
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Zip | 83448-1247
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Country | US
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Telephone | 208-656-2000
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Fax | 208-464-9002
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | SUGAR CITY
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State | ID
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Zip | 83448-0057
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Country | US
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Telephone | 208-656-2000
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Fax | 208-464-9002
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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 | D4717
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1059
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License Number State | SD
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