Provider Demographics
NPI:1164434411
Name:HYDE-CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:HYDE-CENTER, P.L.L.C.
Other - Org Name:FUN DENTIST - CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMSD
Authorized Official - Phone:817-478-2300
Mailing Address - Street 1:4220 LITTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016
Mailing Address - Country:US
Mailing Address - Phone:817-478-2300
Mailing Address - Fax:817-478-4904
Practice Address - Street 1:3101 S. CENTER STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014
Practice Address - Country:US
Practice Address - Phone:817-466-7057
Practice Address - Fax:817-549-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92231223P0221X
1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60005-1OtherTEXAS CHIP PROGAM
TX169951701Medicaid