Provider Demographics
NPI:1629052840
Name:WYCOFF, REID C (DDS)
Entity type:Individual
Prefix:
First Name:REID
Middle Name:C
Last Name:WYCOFF
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 1:8333 GREENWAY BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3687
Mailing Address - Country:US
Mailing Address - Phone:608-442-3300
Mailing Address - Fax:
Practice Address - Street 1:8333 GREENWAY BLVD STE 380
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3687
Practice Address - Country:US
Practice Address - Phone:608-442-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6583-151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063287713Medicaid
NE1767815OtherUNITED CONCORDIA ID