Provider Demographics
NPI:1770700551
Name:HYMES, PAMELA VERONICA (DDS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:VERONICA
Last Name:HYMES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:VERONICA
Other - Last Name:YANCEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10905 FORT WASHINGTON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5843
Mailing Address - Country:US
Mailing Address - Phone:301-203-7035
Mailing Address - Fax:301-203-7038
Practice Address - Street 1:10905 FORT WASHINGTON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5843
Practice Address - Country:US
Practice Address - Phone:301-203-7035
Practice Address - Fax:301-203-7038
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD121886060Medicaid