Provider Demographics
NPI:1639224181
Name:HYSONG & LEPORE PA
Entity type:Organization
Organization Name:HYSONG & LEPORE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HYSONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-384-6000
Mailing Address - Street 1:724 CLOVERLY ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905
Mailing Address - Country:US
Mailing Address - Phone:301-384-6000
Mailing Address - Fax:301-384-7421
Practice Address - Street 1:724 CLOVERLY ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905
Practice Address - Country:US
Practice Address - Phone:301-384-6000
Practice Address - Fax:301-384-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07504122300000X
MD8350122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty