Provider Demographics
NPI:1144741570
Name:TRAINA, WYATT JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WYATT
Middle Name:JOHN
Last Name:TRAINA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1523
Mailing Address - Country:US
Mailing Address - Phone:207-380-4671
Mailing Address - Fax:
Practice Address - Street 1:131 JOHNSON RD STE 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1988
Practice Address - Country:US
Practice Address - Phone:207-775-6348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN44101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics