MEDICARE: DR. STEVEN E WYLIE DMD

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	122300000X	Dentist	DSO37537	PA

General Provider Information

NPI Number	:	1972942688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN E WYLIE DMD

Provider Business Mailing Address
First Line	:	3920 MARKET ST STE 100
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-4202
Country	:	US
Telephone Number	:	717-737-4337
Fax Number	:	717-737-7918

Provider Business Practice Location Address
First Line	:	3920 MARKET ST STE 100
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-4202
Country	:	US
Telephone Number	:	717-737-4337
Fax Number	:	717-737-7918

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	06/17/2013

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