Provider Demographics
NPI:1043933252
Name:BRETT D WYMAN DDS PC
Entity type:Organization
Organization Name:BRETT D WYMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:DAWSON
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-862-9925
Mailing Address - Street 1:1614 N BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2804
Mailing Address - Country:US
Mailing Address - Phone:417-862-9925
Mailing Address - Fax:417-862-4541
Practice Address - Street 1:1614 N BENTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2804
Practice Address - Country:US
Practice Address - Phone:417-862-9925
Practice Address - Fax:417-862-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental