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NPI Code Detail

MEDICARE: DR. ADAM K WYATT DDS

MEDICARE: DR. ADAM K WYATT DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0401007963VA

General Provider Information

NPI Number : 1154392512
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADAM K WYATT DDS
Provider Business Mailing Address
First Line : 1647 ADMIRAL TAUSSIG BLVD
Second Line :
City : NORFOLK
State : VA
Zip : 23511-2803
Country : US
Telephone Number : 757-314-6609
Fax Number :
Provider Business Practice Location Address
First Line : 1647 ADMIRAL TAUSSIG BLVD
Second Line :
City : NORFOLK
State : VA
Zip : 23511-2803
Country : US
Telephone Number : 757-314-6609
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ADAM K WYATT DDS” Practice Location

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