Healthcare Provider Details

I. General information

NPI: 1972942688
Provider Name (Legal Business Name): STEVEN E WYLIE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 MARKET ST STE 100
CAMP HILL PA
17011-4202
US

IV. Provider business mailing address

3920 MARKET ST STE 100
CAMP HILL PA
17011-4202
US

V. Phone/Fax

Practice location:
  • Phone: 717-737-4337
  • Fax: 717-737-7918
Mailing address:
  • Phone: 717-737-4337
  • Fax: 717-737-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDSO37537
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: