Provider Demographics
NPI:1427101427
Name:HYMAN, FREDERIC PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:PHILIP
Last Name:HYMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1378
Mailing Address - Country:US
Mailing Address - Phone:413-528-4680
Mailing Address - Fax:413-528-5394
Practice Address - Street 1:29 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1378
Practice Address - Country:US
Practice Address - Phone:413-528-4680
Practice Address - Fax:413-528-5394
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice