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NPI Code Detail

MEDICARE: MS. TAMMIE LYNN WYRICK DENTAL HYGIENIST

MEDICARE:  MS. TAMMIE LYNN WYRICK  DENTAL HYGIENIST
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
1124Q00000XDental Hygienist7498TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17498OTHERTXREGISTRATION CERTIFICATE

General Provider Information

NPI Number : 1639288848
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMMIE LYNN WYRICK DENTAL HYGIENIST
Provider Business Mailing Address
First Line : 115 S LAUREL AVE
Second Line :
City : LULING
State : TX
Zip : 78648-2624
Country : US
Telephone Number : 830-672-6511
Fax Number : 830-672-6430
Provider Business Practice Location Address
First Line : 228 SAINT GEORGE ST
Second Line :
City : GONZALES
State : TX
Zip : 78629-3910
Country : US
Telephone Number : 830-672-6511
Fax Number : 830-672-6430
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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Directions to “ MS. TAMMIE LYNN WYRICK DENTAL HYGIENIST” Practice Location

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