Provider Demographics
NPI:1295808277
Name:WYMAN, ANDREW JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
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 1:795 NE MIDWAY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2683
Mailing Address - Country:US
Mailing Address - Phone:360-679-3585
Mailing Address - Fax:360-279-8102
Practice Address - Street 1:795 NE MIDWAY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2683
Practice Address - Country:US
Practice Address - Phone:360-679-3585
Practice Address - Fax:360-279-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist