Provider Demographics
NPI:1053426270
Name:HYMAN, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:HYMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5057
Mailing Address - Country:US
Mailing Address - Phone:845-294-2840
Mailing Address - Fax:845-294-2840
Practice Address - Street 1:4504 ROUTE 55
Practice Address - Street 2:DAYTOP VILLAGE DENTAL
Practice Address - City:SWAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12783
Practice Address - Country:US
Practice Address - Phone:845-292-6714
Practice Address - Fax:845-292-6714
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist