Healthcare Provider Details

I. General information

NPI: 1285737262
Provider Name (Legal Business Name): JOHN MILLER HYSON III D.D.S.M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 FULFORD AVE
BEL AIR MD
21014
US

IV. Provider business mailing address

208 FULFORD AVE
BEL AIR MD
21014-3814
US

V. Phone/Fax

Practice location:
  • Phone: 410-836-7800
  • Fax: 410-776-2112
Mailing address:
  • Phone: 410-836-7800
  • Fax: 410-776-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7085
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: