Provider Demographics
NPI:1942224233
Name:WIYGUL, JAMES P (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:WIYGUL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 POPLAR AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3516
Mailing Address - Country:US
Mailing Address - Phone:901-682-4007
Mailing Address - Fax:901-683-4124
Practice Address - Street 1:5340 POPLAR AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3516
Practice Address - Country:US
Practice Address - Phone:901-682-4007
Practice Address - Fax:901-683-4124
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS32631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
638660OtherUNITED CONCORDIA PROVIDER
TN4071304OtherBC/BS PROVIDER #
TN62-1111119OtherTAX ID
TN4071304OtherBC/BS PROVIDER #
TN3225263Medicare PIN