Provider Demographics
NPI:1649589441
Name:HAYDEN FAMILY DENTAL CENTER, PLLC
Entity Type:Organization
Organization Name:HAYDEN FAMILY DENTAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-772-3132
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0007
Mailing Address - Country:US
Mailing Address - Phone:208-772-3132
Mailing Address - Fax:208-772-9742
Practice Address - Street 1:52 W COMMERCE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9221
Practice Address - Country:US
Practice Address - Phone:208-772-3132
Practice Address - Fax:208-772-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD20011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1548331986OtherNPI
WA2006003OtherWA DSHS