Provider Demographics
NPI:1801845003
Name:JOHN C. WYATT DDS & ASSOCIATES PC
Entity Type:Organization
Organization Name:JOHN C. WYATT DDS & ASSOCIATES PC
Other - Org Name:WYATT FAMILY DENTRISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-787-0900
Mailing Address - Street 1:2885 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3607
Mailing Address - Country:US
Mailing Address - Phone:517-787-0900
Mailing Address - Fax:517-787-6363
Practice Address - Street 1:2885 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3607
Practice Address - Country:US
Practice Address - Phone:517-787-0900
Practice Address - Fax:517-787-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty