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General NPI Number Information
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NPI Number | 1073720611
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Entity Type | Organization
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Legal Business Name | JOHN L HYATT DDS PA
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 935 4TH STREET DR NE
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City | HICKORY
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State | NC
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Zip | 28601-3950
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Country | US
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Telephone | 828-328-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 935 4TH STREET DR NE
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City | HICKORY
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State | NC
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Zip | 28601-3950
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Country | US
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Telephone | 828-328-6161
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN L HYATT
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Credential | DDS
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Telephone | 828-328-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 3462
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License Number State | NC
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