Healthcare Provider Details

I. General information

NPI: 1558103713
Provider Name (Legal Business Name): CHRISTOPHER LANE HYNUM D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 LEIGH DR
COLUMBUS MS
39705-3036
US

IV. Provider business mailing address

814 PINE CIR
STARKVILLE MS
39759-3732
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1825
  • Fax:
Mailing address:
  • Phone: 601-618-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4460-24
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: