Provider Demographics
NPI:1972942688
Name:WYLIE, STEVEN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:WYLIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4202
Mailing Address - Country:US
Mailing Address - Phone:717-737-4337
Mailing Address - Fax:717-737-7918
Practice Address - Street 1:3920 MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4202
Practice Address - Country:US
Practice Address - Phone:717-737-4337
Practice Address - Fax:717-737-7918
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO37537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist