Provider Demographics
NPI:1366619991
Name:HYTEN, KENNETH CHARLES
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:HYTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:CHARLES
Other - Last Name:HYTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:12 GINGER CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034
Mailing Address - Country:US
Mailing Address - Phone:618-656-7131
Mailing Address - Fax:618-656-7125
Practice Address - Street 1:2110 TROY RD
Practice Address - Street 2:A
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-2549
Practice Address - Country:US
Practice Address - Phone:618-656-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A12931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist