Healthcare Provider Details

I. General information

NPI: 1336009414
Provider Name (Legal Business Name): BETHANY NOEL WYSS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11221 W POINT DR
FARRAGUT TN
37934-2838
US

IV. Provider business mailing address

11221 W POINT DR
FARRAGUT TN
37934-2838
US

V. Phone/Fax

Practice location:
  • Phone: 865-777-5700
  • Fax:
Mailing address:
  • Phone: 865-777-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12754
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: