Individual
HAYDEN KEVIN SHARP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7093 E SUPER 1 LOOP, ATHOL, ID 83854
(208) 561-9013
(208) 561-9014
Mailing address
PO BOX 1386, HAYDEN, ID 83835-1386
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5441
ID
Other
Enumeration date
05/20/2022
Last updated
01/30/2025
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