Healthcare Provider Details

I. General information

NPI: 1043933252
Provider Name (Legal Business Name): BRETT D WYMAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 N BENTON AVE
SPRINGFIELD MO
65803-2804
US

IV. Provider business mailing address

1614 N BENTON AVE
SPRINGFIELD MO
65803-2804
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-9925
  • Fax: 417-862-4541
Mailing address:
  • Phone: 417-862-9925
  • Fax: 417-862-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRETT DAWSON WYMAN
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 417-862-9925