Provider Demographics
NPI:1790887156
Name:PYATT, ED G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ED
Middle Name:G
Last Name:PYATT
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:PO BOX 707
Mailing Address - Street 2:1006 S ASH
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622
Mailing Address - Country:US
Mailing Address - Phone:417-345-2795
Mailing Address - Fax:417-345-8654
Practice Address - Street 1:1006 S ASH
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622
Practice Address - Country:US
Practice Address - Phone:417-345-2795
Practice Address - Fax:417-345-8654
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0125361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice