Individual
DR. KENNETH ROBERT WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
285 ELM ST, SUITE 200, CUMMING, GA 30040-8233
(770) 887-2915
Mailing address
9020 CHAMPION CT, BALL GROUND, GA 30107-7018
(770) 888-3072
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
012032
GA
Other
Enumeration date
11/10/2006
Last updated
06/11/2014
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