Individual
RUSTIN G HAWKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
509 S MIDDLETON RD STE 101, MIDDLETON, ID 83644-6047
(208) 921-5420
Mailing address
14790 BOULDER CREEK LANE, MIDDLETON, ID 83644
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5397
ID
1223G0001X
General Practice Dentistry
DD5114
NM
Other
Enumeration date
07/01/2019
Last updated
12/16/2024
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