Provider Demographics
NPI:1194004994
Name:GULF COAST PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:GULF COAST PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-832-3111
Mailing Address - Street 1:15236 DEDEAUX RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3161
Mailing Address - Country:US
Mailing Address - Phone:228-832-3111
Mailing Address - Fax:228-832-3117
Practice Address - Street 1:15236 DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3161
Practice Address - Country:US
Practice Address - Phone:228-832-3111
Practice Address - Fax:228-832-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty