MEDICARE: DR. CLEMENS BYATT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN6739	FL

General Provider Information

NPI Number	:	1376710566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLEMENS BYATT DDS

Provider Business Mailing Address
First Line	:	1721 SAINT JOHNS AVE
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-4440
Country	:	US
Telephone Number	:	386-325-8081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 SAINT JOHNS AVE
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-4440
Country	:	US
Telephone Number	:	386-325-8081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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