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General NPI Number Information
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NPI Number | 1366287302
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Entity Type | Individual
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Provider Name | DARRA J HYDE DMD
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Gender | Female
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1120 HIGH ST
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City | BRANDENBURG
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State | KY
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Zip | 40108-1514
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Country | US
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Telephone | 270-422-4923
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Fax |
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Provider Business Mailing Address
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Address Line | 200 SHELBI DR
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City | GUSTON
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State | KY
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Zip | 40142-7052
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11194
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License Number State | KY
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