Provider Demographics
NPI:1003897927
Name:WYCALL, BRIAN TOMS (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:TOMS
Last Name:WYCALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 S CURLEY ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4810
Mailing Address - Country:US
Mailing Address - Phone:443-801-2144
Mailing Address - Fax:
Practice Address - Street 1:3701 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4208
Practice Address - Country:US
Practice Address - Phone:410-327-7639
Practice Address - Fax:410-342-8093
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist