Healthcare Provider Details

I. General information

NPI: 1265756423
Provider Name (Legal Business Name): WAYLAND DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST
WAYLAND MA
01778-4900
US

IV. Provider business mailing address

16 BOSTON POST RD
WAYLAND MA
01778-2434
US

V. Phone/Fax

Practice location:
  • Phone: 508-651-0500
  • Fax:
Mailing address:
  • Phone: 508-358-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ALLEN PUTT
Title or Position: OWNER
Credential: DMD
Phone: 508-358-6108