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General NPI Number Information
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NPI Number | 1215696364
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Entity Type | Organization
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Legal Business Name | MICHAEL WYNN AND ASSOCIATES LLC
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 4608 S HARVARD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-2913
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Country | US
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Telephone | 918-742-7351
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Fax | 918-742-7352
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Provider Business Mailing Address
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Address Line | 4608 S HARVARD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-2913
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Country | US
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Telephone | 918-742-7351
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Fax | 918-742-7352
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JOSEPH WYNN
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Credential | DDS
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Telephone | 918-742-7351
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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 |
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License Number State |
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