Provider Demographics
NPI:1770270878
Name:HYDE, JAVAUNY KRISTOFF
Entity type:Individual
Prefix:DR
First Name:JAVAUNY
Middle Name:KRISTOFF
Last Name:HYDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 VOTIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-3032
Mailing Address - Country:US
Mailing Address - Phone:850-490-3742
Mailing Address - Fax:
Practice Address - Street 1:4500 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-2530
Practice Address - Country:US
Practice Address - Phone:757-707-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7511122300000X
390200000X
VA04014190531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program