Provider Demographics
NPI:1700885621
Name:HYDE, GLEN A (DDS)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:A
Last Name:HYDE
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 1:186 HOSPITAL RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2472
Mailing Address - Country:US
Mailing Address - Phone:931-967-6112
Mailing Address - Fax:931-967-0462
Practice Address - Street 1:186 HOSPITAL RD
Practice Address - Street 2:SUITE 600
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2472
Practice Address - Country:US
Practice Address - Phone:931-967-6112
Practice Address - Fax:931-967-0462
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
TN34041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice