Provider Demographics
NPI:1902211733
Name:HEPWORTH, THANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THANE
Middle Name:
Last Name:HEPWORTH
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 1:602 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57382-2167
Mailing Address - Country:US
Mailing Address - Phone:605-539-1381
Mailing Address - Fax:605-539-1190
Practice Address - Street 1:602 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WESSINGTON SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57382-2167
Practice Address - Country:US
Practice Address - Phone:605-539-1381
Practice Address - Fax:605-539-1190
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist