Individual
MR. WAYNE NOLAN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
9840 E 81ST ST STE 100, TULSA, OK 74133-4583
(918) 496-1155
(918) 496-1167
Mailing address
9840 E 81ST ST STE 100, TULSA, OK 74133-4583
(918) 496-1155
(918) 496-1167
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5563
OK
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
151
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200044110
—
OK
Enumeration date
08/18/2006
Last updated
07/29/2020
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