Provider Demographics
NPI:1114656758
Name:HESS, HAYDEN (DMD)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:
Last Name:HESS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W ROSE HILL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5900
Mailing Address - Country:US
Mailing Address - Phone:208-314-3755
Mailing Address - Fax:
Practice Address - Street 1:2600 W ROSE HILL ST STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5900
Practice Address - Country:US
Practice Address - Phone:208-314-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-54211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice