Provider Demographics
NPI:1407134539
Name:CLINTON HYATT, DDS, PC
Entity Type:Organization
Organization Name:CLINTON HYATT, DDS, PC
Other - Org Name:HYATT FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-589-0496
Mailing Address - Street 1:8711 BEDFORD EULESS RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3851
Mailing Address - Country:US
Mailing Address - Phone:817-589-0496
Mailing Address - Fax:
Practice Address - Street 1:8711 BEDFORD EULESS RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3851
Practice Address - Country:US
Practice Address - Phone:817-589-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty