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General NPI Number Information
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NPI Number | 1093882417
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Entity Type | Individual
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Provider Name | CHRIS K WYSZYNSKI DMD
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | USA DENTAC FORT CAVAZOS 36000 SHOEMAKER LANE SUITE 1051
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City | FORT CAVAZOS
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State | TX
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Zip | 76544-1529
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Country | US
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Telephone | 542-867-4022
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Fax |
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Provider Business Mailing Address
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Address Line | USA DENTAC FORT CAVAZOS 36000 SHOEMAKER LANE, SUITE 1051
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City | FORT CAVAZOS
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State | TX
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Zip | 76544
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Country | US
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Telephone | 254-286-7402
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019021388
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License Number State | IL
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