Provider Demographics
NPI:1164266193
Name:HYDE, NICHOLAS TODD (DMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TODD
Last Name:HYDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2782 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:PA
Mailing Address - Zip Code:15554-8569
Mailing Address - Country:US
Mailing Address - Phone:814-248-8282
Mailing Address - Fax:
Practice Address - Street 1:114 RIDGEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:PA
Practice Address - Zip Code:15554
Practice Address - Country:US
Practice Address - Phone:814-839-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0446931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice