Provider Demographics
NPI:1245346097
Name:STEVEN J HYTEN PC
Entity type:Organization
Organization Name:STEVEN J HYTEN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HYTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:618-656-3100
Mailing Address - Street 1:1005 PLUMMER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4702
Mailing Address - Country:US
Mailing Address - Phone:618-656-3100
Mailing Address - Fax:618-656-3146
Practice Address - Street 1:1005 PLUMMER DR
Practice Address - Street 2:SUITE A
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-4702
Practice Address - Country:US
Practice Address - Phone:618-656-3100
Practice Address - Fax:618-656-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0021651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213081Medicare ID - Type UnspecifiedGROUP