Provider Demographics
NPI:1255457750
Name:WYMANN, JAMIE SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:SCOTT
Last Name:WYMANN
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 1:1555 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-279-4080
Mailing Address - Fax:561-279-4090
Practice Address - Street 1:1555 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BCH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-279-4080
Practice Address - Fax:561-279-4090
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076107900Medicaid