Healthcare Provider Details

I. General information

NPI: 1528193810
Provider Name (Legal Business Name): MICHAEL J HYNEMAN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E MCKELLIPS RD
MESA AZ
85203-2865
US

IV. Provider business mailing address

1905 E MCKELLIPS RD
MESA AZ
85203-2865
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-1949
  • Fax: 490-649-0617
Mailing address:
  • Phone: 480-649-1949
  • Fax: 490-649-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3564
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHAEL J HYNEMAN
Title or Position: DENTIST OWNER
Credential: DMD
Phone: 480-649-1949