Provider Demographics
NPI:1093879116
Name:WYATT, RALPH KURRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:KURRY
Last Name:WYATT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RALPH
Other - Middle Name:KURRY
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:307 ELIZABETH ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2937
Mailing Address - Country:US
Mailing Address - Phone:256-734-1866
Mailing Address - Fax:256-734-1869
Practice Address - Street 1:307 ELIZABETH ST NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2937
Practice Address - Country:US
Practice Address - Phone:256-734-1866
Practice Address - Fax:256-734-1869
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice