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NPI Code Detail

MEDICARE: JAMIE S WYMANN DDS PA

MEDICARE: JAMIE S WYMANN DDS PA
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
1122300000XDentist

General Provider Information

NPI Number : 1053691485
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMIE S WYMANN DDS PA
Provider Business Mailing Address
First Line : 5301 NW 121ST AVE
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-3636
Country : US
Telephone Number : 516-279-4080
Fax Number : 516-496-1351
Provider Business Practice Location Address
First Line : 5301 NW 121 AVENUE
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33076-3636
Country : US
Telephone Number : 516-279-4080
Fax Number : 516-496-1351
Authorized Official
Title or Position : OWNER
Name : JAMIE WYMAN
Credential :
Telephone Number : 516-279-4080
Provider Enumeration Date : 08/17/2011
Last Update Date : 08/17/2011

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Directions to “JAMIE S WYMANN DDS PA ” Practice Location

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