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General NPI Number Information
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NPI Number | 1508167313
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Entity Type | Organization
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Legal Business Name | ROBERT J. WYGONSKI D.M.D., P.C.
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 700 ATTUCKS LN SUITE 2E
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City | HYANNIS
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State | MA
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Zip | 02601-1809
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Country | US
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Telephone | 508-775-5676
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Fax | 508-775-4163
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Provider Business Mailing Address
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Address Line | 700 ATTUCKS LN SUITE 2E
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City | HYANNIS
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State | MA
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Zip | 02601-1809
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Country | US
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Telephone | 508-775-5676
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Fax | 508-775-4163
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Authorized Official
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Title or Position | ORAL AND MAXILLOFACIAL SURGEON
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Name | DR. ROBERT J WYGONSKI
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Credential | DMD
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Telephone | 508-775-5676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019609
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License Number State | MA
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