Provider Demographics
NPI:1548315096
Name:RAY H. HYDE, DDS, PA
Entity type:Organization
Organization Name:RAY H. HYDE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-692-5112
Mailing Address - Street 1:4245 KEMP BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2824
Mailing Address - Country:US
Mailing Address - Phone:940-692-5112
Mailing Address - Fax:940-692-5342
Practice Address - Street 1:4245 KEMP BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2824
Practice Address - Country:US
Practice Address - Phone:940-692-5112
Practice Address - Fax:940-692-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty