Provider Demographics
NPI:1285683995
Name:WYNN, MICHAEL MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MINH
Last Name:WYNN
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 1:408 S BEACH BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1887
Mailing Address - Country:US
Mailing Address - Phone:714-826-7700
Mailing Address - Fax:714-952-8673
Practice Address - Street 1:408 S BEACH BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1887
Practice Address - Country:US
Practice Address - Phone:714-826-7700
Practice Address - Fax:714-952-8673
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice