Healthcare Provider Details

I. General information

NPI: 1700813144
Provider Name (Legal Business Name): RONALD M WAYT DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N BROADWAY SUITE 7
TECUMSEH OK
74873-0219
US

IV. Provider business mailing address

PO BOX 219
TECUMSEH OK
74873-0219
US

V. Phone/Fax

Practice location:
  • Phone: 405-598-6259
  • Fax: 405-598-6259
Mailing address:
  • Phone: 405-598-6259
  • Fax: 405-598-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3083
License Number StateOK

VIII. Authorized Official

Name: RONALD MELVIN WAYT
Title or Position: DENTIST PRESIDENT
Credential: DDS
Phone: 405-518-6259