Individual
MR. KENNETH W WYMAN II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1225 WELL ST, FAIRBANKS, AK 99701-2836
(907) 456-6850
(907) 456-7510
Mailing address
PO BOX 80299, FAIRBANKS, AK 99708-0299
(907) 457-8739
(907) 456-7510
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
UNKNOWN
AK
1223P0221X
Pediatric Dentistry
UNKNOWN
AK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
UNKNOWN
AK
Other
Enumeration date
04/21/2008
Last updated
04/21/2008
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