Individual
ERIC L HYDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS PLLC
Contact information
Practice address
15236 DEDEAUX RD, GULFPORT, MS 39503-3161
(228) 832-3111
(228) 832-3117
Mailing address
15236 DEDEAUX RD, GULFPORT, MS 39503-3161
(228) 832-3111
(228) 832-3117
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3330-05
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03781882
—
MS
01
—
04472876
MEDICAID GROUP NUMBER
MS
01
—
510579833
TAX I.D. NUMBER
MS
Enumeration date
08/12/2006
Last updated
06/24/2021
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