Provider Demographics
NPI:1437564887
Name:AIRHEART, BLAIRE HYDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAIRE
Middle Name:HYDE
Last Name:AIRHEART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BLAIRE
Other - Middle Name:ELIZABETH
Other - Last Name:HYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5540 OLD JACKSONVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3378
Mailing Address - Country:US
Mailing Address - Phone:903-597-2121
Mailing Address - Fax:
Practice Address - Street 1:5540 OLD JACKSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3378
Practice Address - Country:US
Practice Address - Phone:903-597-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice