Healthcare Provider Details

I. General information

NPI: 1942224233
Provider Name (Legal Business Name): JAMES P WIYGUL DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 POPLAR AVE SUITE #1
MEMPHIS TN
38119-3516
US

IV. Provider business mailing address

5340 POPLAR AVE SUITE #1
MEMPHIS TN
38119-3516
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-4007
  • Fax: 901-683-4124
Mailing address:
  • Phone: 901-682-4007
  • Fax: 901-683-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS3263
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: