Provider Demographics
NPI:1518379601
Name:WYNNE, WILLIAM TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TYLER
Last Name:WYNNE
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 1:100 STADIUM OAKS DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8961
Mailing Address - Country:US
Mailing Address - Phone:336-793-0577
Mailing Address - Fax:336-778-2437
Practice Address - Street 1:100 STADIUM OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8961
Practice Address - Country:US
Practice Address - Phone:336-793-0577
Practice Address - Fax:336-778-2437
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice