Wilson, Wyatt William

Wilson, Wyatt William is an individual health care provider with primary practice located at 19029 Beavercreek Rd , Oregon City OR 97045-9537. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Wilson, Wyatt William can be contacted via phone (503) 941-3064.

Contact Information

Primary practice address
19029 Beavercreek Rd Oregon City OR 97045-9537
Phone: (503) 941-3064
Fax: (503) 941-3075
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D10058 Oregon

Profile Details

NPI number 1023423639
LBN Legal business name Wilson, Wyatt William
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2014
Last updated Apr 20th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023423639 NPPES
Oregon MEDICAID 500675716

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