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NPI Code Detail

MEDICARE: JOHN C. WYATT DDS & ASSOCIATES PC

MEDICARE: JOHN C. WYATT DDS & ASSOCIATES PC
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 DentistryMI

General Provider Information

NPI Number : 1801845003
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN C. WYATT DDS & ASSOCIATES PC
Provider Business Mailing Address
First Line : 2885 SPRING ARBOR RD
Second Line :
City : JACKSON
State : MI
Zip : 49203-3607
Country : US
Telephone Number : 517-787-0900
Fax Number : 517-787-6363
Provider Business Practice Location Address
First Line : 2885 SPRING ARBOR RD
Second Line :
City : JACKSON
State : MI
Zip : 49203-3607
Country : US
Telephone Number : 517-787-0900
Fax Number : 517-787-6363
Authorized Official
Title or Position : PRESIDENT
Name : JOHN C WYATT
Credential : D.D.S.
Telephone Number : 517-787-0900
Provider Enumeration Date : 05/08/2006
Last Update Date : 07/21/2022

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