MEDICARE: DR. STEVEN ROBERT WYNN D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	34447	CA

General Provider Information

NPI Number	:	1033387485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN ROBERT WYNN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1901 WESTCLIFF DR STE 1
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5505
Country	:	US
Telephone Number	:	949-642-2626
Fax Number	:	949-642-2762

Provider Business Practice Location Address
First Line	:	1901 WESTCLIFF DR STE 1
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5505
Country	:	US
Telephone Number	:	949-642-2626
Fax Number	:	949-642-2762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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