Provider Demographics
NPI:1376710566
Name:BYATT, CLEMENS (DDS)
Entity type:Individual
Prefix:DR
First Name:CLEMENS
Middle Name:
Last Name:BYATT
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 1:1721 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-4440
Mailing Address - Country:US
Mailing Address - Phone:386-325-8081
Mailing Address - Fax:
Practice Address - Street 1:1721 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4440
Practice Address - Country:US
Practice Address - Phone:386-325-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN6739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist