Provider Demographics
NPI:1386203164
Name:HYDES, MARY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY ELIZABETH
Middle Name:
Last Name:HYDES
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 1:2801 N WOLCOTT AVE UNIT O
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4159
Mailing Address - Country:US
Mailing Address - Phone:954-296-8565
Mailing Address - Fax:
Practice Address - Street 1:8410 S HOLLAND RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6062
Practice Address - Country:US
Practice Address - Phone:773-420-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019032192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program