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General NPI Number Information
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NPI Number | 1003349614
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Entity Type | Individual
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Provider Name | JONATHAN EDWARD WYBLE DMD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 247 BILTMORE AVE
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City | ASHEVILLE
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State | NC
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Zip | 28801
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Country | US
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Telephone | 828-350-1076
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Fax |
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Provider Business Mailing Address
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Address Line | 120 DEMKO LN APT 117
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City | ASHEVILLE
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State | NC
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Zip | 28806-3382
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Country | US
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Telephone | 813-924-6876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 11595
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License Number State | NC
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