Provider Demographics
NPI:1568511434
Name:WYLIE, ROBERT T (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:WYLIE
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 1:88 NIAGARA ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150
Mailing Address - Country:US
Mailing Address - Phone:716-343-6711
Mailing Address - Fax:716-343-6710
Practice Address - Street 1:88 NIAGARA ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:716-343-6711
Practice Address - Fax:716-343-6710
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0339151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice