Provider Demographics
NPI:1952585549
Name:DRS HYDE,BAILEY, AND CREMER
Entity type:Organization
Organization Name:DRS HYDE,BAILEY, AND CREMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CREMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PA
Authorized Official - Phone:817-427-1700
Mailing Address - Street 1:750 MID CITIES BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2792
Mailing Address - Country:US
Mailing Address - Phone:817-427-1700
Mailing Address - Fax:
Practice Address - Street 1:750 MID CITIES BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2792
Practice Address - Country:US
Practice Address - Phone:817-427-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty