Wyatt Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

License

58495 Issued in CA

Legal business name

WYATT DENTAL CORPORATION

Practice address

1100 Sonoma Ave Ste B
Santa Rosa, CA 95405-8901

Phone

(707) 546-3791

Fax

(707) 546-9732

NPI assigned

Jun 19, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cherylin H. Wyatt, DDSNPI 1811128374

Title

Dentist

Phone

(707) 546-3791

Specialties & licenses 1

Addresses

Other names 1

• Cherylin H. Wyatt Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cherylin H Wyatt, DDS

  • General Practice Dentistry
  • Santa Rosa, CA
  • NPI 1811128374
  NPD Authorized official
• J. Patrick Hurley, D.D.S.

  • Dentist
  • Santa Rosa, CA
  • NPI 1407903768
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1184038929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SONOMA AVE STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058901",
            "telephone_number": "707-546-3791",
            "fax_number": "707-546-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SONOMA AVE STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058901",
            "telephone_number": "707-546-3791",
            "fax_number": "707-546-9732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYATT DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-19",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "CHERYLIN",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "707-546-3791",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "58495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherylin H. Wyatt",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Erica Shu-Yeu Wu, O.D.
• Justin Wu, DDS
• Wei Der Wu, M.D.
• Sophia Rose Wuest
• Heidi Wurzburg, RN, MSN, FNP
• Cherylin H Wyatt, DDS
• Angela Wyble, PAC
• Ashleigh Wylie
• Catherine Wynia, M.A.
• Jeffrey Y Xu, MD

• Dentist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.