Provider Demographics
NPI:1003981721
Name:WYATT, WILLIAM M (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:WYATT
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Gender:M
Credentials:DDS
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Mailing Address - Street 1:3701 KIRBY DR
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3900
Mailing Address - Country:US
Mailing Address - Phone:512-238-7449
Mailing Address - Fax:512-238-9615
Practice Address - Street 1:117 LOUIS HENNA BLVD
Practice Address - Street 2:SUITE B-230
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7343
Practice Address - Country:US
Practice Address - Phone:512-238-7449
Practice Address - Fax:512-238-9615
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TX216341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery