Provider Demographics
NPI:1285737262
Name:HYSON, JOHN MILLER III (DDSMSD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MILLER
Last Name:HYSON
Suffix:III
Gender:M
Credentials:DDSMSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FULFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3814
Mailing Address - Country:US
Mailing Address - Phone:410-836-7800
Mailing Address - Fax:410-776-2112
Practice Address - Street 1:208 FULFORD AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-836-7800
Practice Address - Fax:410-776-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA953866OtherUNITED CONCORDIA
PA978980OtherUNITED CONCORDIA