Provider Demographics
NPI:1326197872
Name:DYER, CLYDE GREGORY (DDS,FAGD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:GREGORY
Last Name:DYER
Suffix:
Gender:M
Credentials:DDS,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E CARTWRIGHT RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6063
Mailing Address - Country:US
Mailing Address - Phone:972-329-2442
Mailing Address - Fax:972-329-2452
Practice Address - Street 1:820 E CARTWRIGHT RD STE 140
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6063
Practice Address - Country:US
Practice Address - Phone:972-329-2442
Practice Address - Fax:972-329-2452
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice