Provider Demographics
NPI:1134477417
Name:WYGANT, MICHAEL ERIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIK
Last Name:WYGANT
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 1:2590 VILLAMONTE CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1473
Mailing Address - Country:US
Mailing Address - Phone:206-669-5015
Mailing Address - Fax:
Practice Address - Street 1:5301 MISSION OAKS BLVD STE B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5426
Practice Address - Country:US
Practice Address - Phone:805-482-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist