Provider Demographics
NPI:1508972340
Name:HYTEN, STEVEN JOSEPH (DMD,MS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:HYTEN
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 PLUMMER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4702
Mailing Address - Country:US
Mailing Address - Phone:618-656-3100
Mailing Address - Fax:618-656-3146
Practice Address - Street 1:1005 PLUMMER DR
Practice Address - Street 2:SUITE A
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-4702
Practice Address - Country:US
Practice Address - Phone:618-656-3100
Practice Address - Fax:618-656-3146
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.025576122300000X
IL021.0021651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25395Medicare ID - Type UnspecifiedPROVIDER