Organization
J.MICHAEL WYATT INC.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY MICHAEL WYATT D.D.S. (PRESIDENT/DENTIST)
(405) 842-0033
Entity
Organization
Contact information
Practice address
736 NW 63RD ST, OKLAHOMA CITY, OK 73116-7602
(405) 842-0033
(405) 842-0045
Mailing address
736 NW 63RD ST, OKLAHOMA CITY, OK 73116-7602
(405) 842-0033
(405) 842-0045
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
4910
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134252695
J.MICHAEL WYATT INC.,P.C.
OK
Enumeration date
04/22/2008
Last updated
04/22/2008
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