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General NPI Number Information
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NPI Number | 1154436475
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Entity Type | Individual
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Provider Name | REBECCA ANN WYATT DDS
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5196 S YALE AVENUE
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City | TULSA
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State | OK
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Zip | 74135
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Country | US
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Telephone | 918-664-1888
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Fax | 918-664-9037
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Provider Business Mailing Address
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Address Line | PO BOX 3040
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City | BROKEN ARROW
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State | OK
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Zip | 74013
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Country | US
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Telephone | 918-664-1888
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Fax | 918-664-9037
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 5306
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License Number State | OK
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