Provider Demographics
NPI:1811488588
Name:HYSA, SHERIF (DDS)
Entity type:Individual
Prefix:DR
First Name:SHERIF
Middle Name:
Last Name:HYSA
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 1:2120 HIGHLAND KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3574
Mailing Address - Country:US
Mailing Address - Phone:252-202-7573
Mailing Address - Fax:
Practice Address - Street 1:2685 CELANESE RD STE 116
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2993
Practice Address - Country:US
Practice Address - Phone:803-970-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100831223G0001X
NC109991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA