Provider Demographics
NPI:1497831861
Name:DAVID G WYMAN DMD PC
Entity Type:Organization
Organization Name:DAVID G WYMAN DMD PC
Other - Org Name:ARLINGTON CENTER FOR COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-646-4400
Mailing Address - Street 1:1064 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4311
Mailing Address - Country:US
Mailing Address - Phone:781-646-4400
Mailing Address - Fax:781-648-1386
Practice Address - Street 1:1064 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4311
Practice Address - Country:US
Practice Address - Phone:781-646-4400
Practice Address - Fax:781-648-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty