Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901022792 | MI |
NPI | 1003394719 |
---|---|
Provider Name | Chelsey Ann Hyde |
First Address | Goodrich, MI 48438-9245 |
Second Address | Goodrich, MI 48438-9245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2018 |
Last Update Date | 03/08/2018 |