Provider Demographics
NPI:1669917902
Name:CLEARWATER DENTISTRY
Entity type:Organization
Organization Name:CLEARWATER DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-710-6005
Mailing Address - Street 1:3006 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4313
Mailing Address - Country:US
Mailing Address - Phone:727-233-3030
Mailing Address - Fax:
Practice Address - Street 1:3006 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4313
Practice Address - Country:US
Practice Address - Phone:727-233-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty