Provider Demographics
NPI:1013153279
Name:WYATT AND POUND FAMILY DENTISTRY, P.L.C.
Entity Type:Organization
Organization Name:WYATT AND POUND FAMILY DENTISTRY, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
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:2008-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental