Provider Demographics
NPI:1578874525
Name:HYATT, CLINTON YARDLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:YARDLEY
Last Name:HYATT
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 1:8711 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:801-836-4487
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:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice