Provider Demographics
NPI:1487817391
Name:HYRE, MAE A (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:A
Last Name:HYRE
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PENNSYLVANIA AVE 302
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3390
Mailing Address - Country:US
Mailing Address - Phone:304-388-2950
Mailing Address - Fax:304-388-2951
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 209
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1842
Practice Address - Country:US
Practice Address - Phone:304-388-3290
Practice Address - Fax:304-388-3186
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26631204E00000X
WV41881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery