Provider Demographics
NPI:1053501031
Name:HYDE, BRANDY L (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:HYDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 COWAN RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-2023
Mailing Address - Country:US
Mailing Address - Phone:228-896-7404
Mailing Address - Fax:228-896-6048
Practice Address - Street 1:512 COWAN RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-2023
Practice Address - Country:US
Practice Address - Phone:228-896-7404
Practice Address - Fax:228-896-6048
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3381-061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice