Provider Demographics
NPI:1578785861
Name:HYDE, KENNETH R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:HYDE
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:911 WALL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2549
Mailing Address - Country:US
Mailing Address - Phone:219-462-3537
Mailing Address - Fax:219-462-0366
Practice Address - Street 1:911 WALL ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2549
Practice Address - Country:US
Practice Address - Phone:219-462-3537
Practice Address - Fax:219-462-0366
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN72461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics