Provider Demographics
NPI:1922101906
Name:JOHN M HYSON III D.D.S. P.A.
Entity Type:Organization
Organization Name:JOHN M HYSON III D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:HYSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDSMSD
Authorized Official - Phone:410-821-5553
Mailing Address - Street 1:1206 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6217
Mailing Address - Country:US
Mailing Address - Phone:410-821-5553
Mailing Address - Fax:410-825-7213
Practice Address - Street 1:1206 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6217
Practice Address - Country:US
Practice Address - Phone:410-821-5553
Practice Address - Fax:410-825-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA953866OtherUNITED CONCORDIA
MD19811875OtherLABCORE
MD326216OtherQUEST
MD326067OtherQUEST
PA978980OtherUNITED CONCORDIA