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General NPI Number Information
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NPI Number | 1194704098
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Entity Type | Individual
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Provider Name | DONALD SCOTT WYATT D.D.SS
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12316 N MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-8166
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Country | US
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Telephone | 405-373-2255
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Fax | 405-373-2256
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Provider Business Mailing Address
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Address Line | 12316 N MUSTANG RD
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City | YUKON
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State | OK
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Zip | 73099-8166
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Country | US
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Telephone | 405-373-2255
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Fax | 405-373-2256
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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 | 4778
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License Number State | OK
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