MEDICARE: DR. MELVILLE CECIL WYSE D.D.S., M.P.H.

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	07057	MD

General Provider Information

NPI Number	:	1700981826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVILLE CECIL WYSE D.D.S., M.P.H.

Provider Business Mailing Address
First Line	:	6495 NEW HAMPSHIRE AVE
Second Line	:	SUITE 113
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3245
Country	:	US
Telephone Number	:	301-270-2818
Fax Number	:	301-270-9488

Provider Business Practice Location Address
First Line	:	6495 NEW HAMPSHIRE AVE
Second Line	:	SUITE 113
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3245
Country	:	US
Telephone Number	:	301-270-2818
Fax Number	:	301-270-9488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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