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General NPI Number Information
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NPI Number | 1265756423
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Entity Type | Organization
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Legal Business Name | WAYLAND DENTAL, LLC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 131 MAIN ST
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City | WAYLAND
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State | MA
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Zip | 01778-4900
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Country | US
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Telephone | 508-651-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 16 BOSTON POST RD
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City | WAYLAND
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State | MA
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Zip | 01778-2434
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Country | US
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Telephone | 508-358-6108
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ALLEN PUTT
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Credential | DMD
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Telephone | 508-358-6108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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