Provider Demographics
NPI:1073720611
Name:JOHN L HYATT DDS PA
Entity Type:Organization
Organization Name:JOHN L HYATT DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-328-6161
Mailing Address - Street 1:935 4TH STREET DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3950
Mailing Address - Country:US
Mailing Address - Phone:828-328-6161
Mailing Address - Fax:
Practice Address - Street 1:935 4TH STREET DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3950
Practice Address - Country:US
Practice Address - Phone:828-328-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty