NPIMap

Organization Active NPI

David a Wyatt, DDS, LLS

  • Dentist
  • Boardman, OH
National Provider Identifier
1811093545
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
18305 Issued in OH
Legal business name
DAVID A WYATT, DDS, LLS
Practice address
99 Debartolo PL
Boardman, OH 44512
Phone
(330) 758-2348
Fax
(330) 758-0481
NPI assigned
Sep 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

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

Authorized official

Name
Dr. David A Wyatt, DDSNPI 1902081276
Title
Owner
Phone
(330) 758-2348

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 18305 OH Primary

Addresses

Primary practice location

99 Debartolo PL
Boardman, OH 44512

Mailing address

99 Debartolo PL
Boardman, OH 44512
Phone (330) 758-2348

National Provider Directory

National Provider Directory

Locations

99 Debartolo Pl
Boardman, OH 44512
Phone (330) 758-2348

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1811093545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 DEBARTOLO PL",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "44512",
            "telephone_number": "330-758-2348",
            "fax_number": "330-758-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 DEBARTOLO PL",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "44512",
            "telephone_number": "330-758-2348",
            "fax_number": "330-758-0481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID A WYATT, DDS, LLS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-758-2348",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "18305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; 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.