Provider Demographics
NPI:1972326320
Name:HYDE FAMILY DENTISTRY PLC
Entity type:Organization
Organization Name:HYDE FAMILY DENTISTRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DARRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-309-8638
Mailing Address - Street 1:200 SHELBI DR
Mailing Address - Street 2:
Mailing Address - City:GUSTON
Mailing Address - State:KY
Mailing Address - Zip Code:40142-7052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 HIGH ST
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1514
Practice Address - Country:US
Practice Address - Phone:270-422-4923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental