Provider Demographics
NPI:1508167313
Name:ROBERT J. WYGONSKI D.M.D., P.C.
Entity Type:Organization
Organization Name:ROBERT J. WYGONSKI D.M.D., P.C.
Other - Org Name:CAPE & ISLANDS ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WYGONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-775-5676
Mailing Address - Street 1:700 ATTUCKS LN
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1809
Mailing Address - Country:US
Mailing Address - Phone:508-775-5676
Mailing Address - Fax:508-775-4163
Practice Address - Street 1:700 ATTUCKS LN
Practice Address - Street 2:SUITE 2E
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1809
Practice Address - Country:US
Practice Address - Phone:508-775-5676
Practice Address - Fax:508-775-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0196091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty