Rustin G Hawker, DDS
Individual provider Active NPI Dentist · Middleton, ID
NPI 1912569732 · NPPES record last updated Dec 16, 2024
Key facts
- NPI
- 1912569732
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5397 (ID)
- Practice address
- 509 S Middleton Rd Ste 101
Middleton, ID 83644-6047 - Phone
- (208) 921-5420
- NPI assigned
- Jul 1, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5397 | ID | MD | Dentist |
| DD5114 | NM | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD5114 | NM | |
| Dentist | 122300000X | 5397 | ID | Yes |
Addresses
Primary practice location
509 S Middleton Rd Ste 101
Middleton, ID 83644-6047
Mailing address
14790 Boulder Creek Lane
Middleton, ID 83644
Other providers in Middleton, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.