Provider Demographics
NPI:1366538910
Name:DYM, HARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:DYM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3750
Mailing Address - Country:US
Mailing Address - Phone:718-377-5668
Mailing Address - Fax:718-377-4545
Practice Address - Street 1:1001 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3750
Practice Address - Country:US
Practice Address - Phone:718-377-5668
Practice Address - Fax:718-377-4545
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0366171223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00956721Medicaid
NYD7E891Medicare ID - Type Unspecified