Provider Demographics
NPI:1497484646
Name:JONES, WYATT STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WYATT
Middle Name:STEPHEN
Last Name:JONES
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 1:215 W SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:ME
Mailing Address - Zip Code:04677-3201
Mailing Address - Country:US
Mailing Address - Phone:918-931-0937
Mailing Address - Fax:
Practice Address - Street 1:271 MAIN ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3606
Practice Address - Country:US
Practice Address - Phone:207-255-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist