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General NPI Number Information
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NPI Number | 1881612810
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Entity Type | Individual
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Provider Name | BRUCE KEVIN WYLES DDS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 134 D LADYS ISLAND DRIVE
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City | BEAUFORT
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State | SC
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Zip | 29907
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Country | US
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Telephone | 843-838-1431
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Fax | 843-522-9931
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Provider Business Mailing Address
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Address Line | 134 D LADYS ISLAND DRIVE
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City | BEAUFORT
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State | SC
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Zip | 29907
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Country | US
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Telephone | 843-838-1431
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Fax | 843-522-9931
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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 | 2607
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License Number State | SC
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