Provider Demographics
NPI:1134239205
Name:HYER, MARK JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:HYER
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 1:1644 OAK TREE TER
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3065
Mailing Address - Country:US
Mailing Address - Phone:626-335-7444
Mailing Address - Fax:
Practice Address - Street 1:625 E ARROW HWY
Practice Address - Street 2:STE 4
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6521
Practice Address - Country:US
Practice Address - Phone:626-963-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA357341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice