Provider Demographics
NPI:1285784116
Name:HAYHURST, SCOTT EDWARD (DMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:EDWARD
Last Name:HAYHURST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 W RIVER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7113
Mailing Address - Country:US
Mailing Address - Phone:208-938-9768
Mailing Address - Fax:
Practice Address - Street 1:7337 NORTHVIEW ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7362
Practice Address - Country:US
Practice Address - Phone:208-376-7721
Practice Address - Fax:208-327-3570
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD35371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice