Provider Demographics
NPI:1497007918
Name:HYDEN, PEGGY HARRIS
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:HARRIS
Last Name:HYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:HARRIS
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1104 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4638
Mailing Address - Country:US
Mailing Address - Phone:575-302-6677
Mailing Address - Fax:
Practice Address - Street 1:1104 N SHORE DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4638
Practice Address - Country:US
Practice Address - Phone:575-302-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH535124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist