Provider Demographics
NPI:1285017962
Name:HVIDSTON, LUKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:HVIDSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56549-0160
Mailing Address - Country:US
Mailing Address - Phone:218-483-3311
Mailing Address - Fax:
Practice Address - Street 1:500 6TH ST
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:MN
Practice Address - Zip Code:56549-0160
Practice Address - Country:US
Practice Address - Phone:218-483-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist