MEDICARE: ANDREW J WYMAN 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1164370995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW J WYMAN DDS

Provider Business Mailing Address
First Line	:	795 NE MIDWAY BLVD STE 201
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-2683
Country	:	US
Telephone Number	:	360-679-3585
Fax Number	:	360-675-2521

Provider Business Practice Location Address
First Line	:	795 NE MIDWAY BLVD STE 201
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-2683
Country	:	US
Telephone Number	:	360-679-3585
Fax Number	:	360-675-2521

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KORIANNE ELIZABETH GHEEN
Credential	:	RDA
Telephone Number	:	360-320-9897

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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