Individual
DR. ELLEN RENEE WYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
104 GRANT ST, NILES, MI 49120-2201
(269) 683-1077
(269) 684-5305
Mailing address
104 GRANT ST, NILES, MI 49120-2201
(269) 683-1077
(269) 684-5305
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901015477
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4498490
—
MI
Enumeration date
12/06/2006
Last updated
03/03/2015
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