Healthcare Provider Details

I. General information

NPI: 1487877874
Provider Name (Legal Business Name): T M WYLAND DENTAL LAB II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 HALLOCK YOUNG RD SW
WARREN OH
44481-9636
US

IV. Provider business mailing address

947 HALLOCK YOUNG RD SW
WARREN OH
44481-9636
US

V. Phone/Fax

Practice location:
  • Phone: 330-824-2515
  • Fax: 330-824-2333
Mailing address:
  • Phone: 330-824-2515
  • Fax: 330-824-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MYRON KENNETH BIDDLE III
Title or Position: TREASURER
Credential:
Phone: 814-946-8189