Provider Demographics
NPI:1184612319
Name:WYMAN, FREDERICK NOBEL (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:NOBEL
Last Name:WYMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1342
Mailing Address - Country:US
Mailing Address - Phone:410-778-4088
Mailing Address - Fax:410-778-2017
Practice Address - Street 1:111 SPRING AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1342
Practice Address - Country:US
Practice Address - Phone:410-778-4088
Practice Address - Fax:410-778-2017
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD45441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice