Provider Demographics
NPI:1467503128
Name:WYATT, PATRICK RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RAY
Last Name:WYATT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12528 WARWICK BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2676
Mailing Address - Country:US
Mailing Address - Phone:757-595-7990
Mailing Address - Fax:757-595-7991
Practice Address - Street 1:12528 WARWICK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2676
Practice Address - Country:US
Practice Address - Phone:757-595-7990
Practice Address - Fax:757-595-7991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA054981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics