Provider Demographics
NPI:1710270590
Name:DYE, JARED ERIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ERIC
Last Name:DYE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N WALDRON ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1133
Mailing Address - Country:US
Mailing Address - Phone:620-663-1141
Mailing Address - Fax:620-663-1373
Practice Address - Street 1:2301 N WALDRON ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1133
Practice Address - Country:US
Practice Address - Phone:620-663-1141
Practice Address - Fax:620-663-1373
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD10741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1548304710OtherBC/BS OF SD
SD1548304710Medicaid
IA1548304710OtherBC/BS OF IA
IA1548304710Medicaid
NE1548304710Medicaid