Brett Dawson Wyman, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

015514 Issued in MO

Practice address

1614 N Benton Ave
Springfield, MO 65803-2804

Phone

(417) 862-9925

Fax

(417) 862-4541

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brett D Wyman DDS PC

  • Dental Clinic/Center
  • Springfield, MO
  • NPI 1043933252
  NPD Authorized official
• Gentle Dental Centers of the Ozrks, LLC Brett D Wyman Sole Member

  • Dental Clinic/Center
  • Branson, MO
  • NPI 1316660533
  NPD Authorized official

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366599391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 N BENTON AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658032804",
            "telephone_number": "417-862-9925",
            "fax_number": "417-862-4541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 N BENTON AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658032804",
            "telephone_number": "417-862-9925",
            "fax_number": "417-862-4541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "BRETT",
        "middle_name": "DAWSON",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "015514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andy Wu, PHARM. D.
• Kara Wu
• Ted Wunderlich, PSY.D.
• Andrew Wylie, DO
• Erin Wylie, BCBA
• Allyson Wynn
• William Wynn III
• Robert Bradley Wyrsch, MD
• James M Xavier, OTR
• Amulya Yadlapalli, MD

• Dentist in Springfield, MO
• Providers in Springfield, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.