Provider Demographics
NPI:1053691485
Name:JAMIE S WYMANN DDS PA
Entity type:Organization
Organization Name:JAMIE S WYMANN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-279-4080
Mailing Address - Street 1:5301 NW 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3636
Mailing Address - Country:US
Mailing Address - Phone:516-279-4080
Mailing Address - Fax:516-496-1351
Practice Address - Street 1:5301 NW 121 AVENUE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3636
Practice Address - Country:US
Practice Address - Phone:516-279-4080
Practice Address - Fax:516-496-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty