Provider Demographics
NPI:1700525276
Name:HUETT, HAYDEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAYDEN
Middle Name:
Last Name:HUETT
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 1:1274 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4707
Mailing Address - Country:US
Mailing Address - Phone:479-530-1757
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-8753
Practice Address - Country:US
Practice Address - Phone:479-787-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11899122300000X, 1223G0001X
AR4645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice