Active NPI
Tracy D Wyatt, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Las Vegas, NV
National Provider Identifier
1780878033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- S3-163
- Practice address
- 7550 W Lake Mead Blvd
Suite 6
Las Vegas, NV 89128-1001 - Phone
- (702) 242-9777
- NPI assigned
- Aug 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | S3-163 | NV | Primary |
Addresses
Primary practice location
7550 W Lake Mead Blvd
Suite 6
Las Vegas, NV 89128-1001
Mailing address
7550 W. Lake Mead Blvd
Suite 6
Las Vegas, NV 89128-1001
Phone (702) 242-9777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S3-163 | NV | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214352000000",
"number": "1780878033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7550 W. LAKE MEAD BLVD",
"address_2": "SUITE 6",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891281001",
"telephone_number": "702-242-9777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7550 W LAKE MEAD BLVD",
"address_2": "SUITE 6",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891281001",
"telephone_number": "702-242-9777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "TRACY",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-29",
"last_updated": "2008-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NV",
"license": "S3-163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.