Provider Demographics
NPI:1891904447
Name:WYATT, WILLIAM EMERSON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EMERSON
Last Name:WYATT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2717 CROSS TIMBERS RD
Mailing Address - Street 2:#424
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2706
Mailing Address - Country:US
Mailing Address - Phone:972-355-2222
Mailing Address - Fax:972-355-3234
Practice Address - Street 1:2717 CROSS TIMBERS RD
Practice Address - Street 2:#424
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2706
Practice Address - Country:US
Practice Address - Phone:972-355-2222
Practice Address - Fax:972-355-3234
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX125281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice