Provider Demographics
NPI:1356402077
Name:HYDE, THOMAS J (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:HYDE
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 1:5560 GRATIOT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6091
Mailing Address - Country:US
Mailing Address - Phone:989-401-6591
Mailing Address - Fax:989-401-6596
Practice Address - Street 1:5560 GRATIOT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6091
Practice Address - Country:US
Practice Address - Phone:989-401-6591
Practice Address - Fax:989-401-6591
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143091223S0112X
ORD59621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1725138Medicaid
MI2983431Medicaid
MIG37613001Medicare ID - Type Unspecified
MI2983431Medicaid