MEDICARE: DR. LYDIA CLAIRE WYATT DDS

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	1223G0001X	General Practice Dentistry	4340	NV

General Provider Information

NPI Number	:	1942377304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYDIA CLAIRE WYATT DDS

Provider Business Mailing Address
First Line	:	72 PANORAMA CREST AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-7831
Country	:	US
Telephone Number	:	702-220-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 N TOWN CENTER DR
Second Line	:	SUITE 170
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-6379
Country	:	US
Telephone Number	:	702-220-9555
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	11/05/2009

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