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Contact Information

GARY L WYATT, DDS
1801 NEWPORT BOULEVARD
SUITE C
COSTA MESA, CA92627
 Phone: 949-650-1030
 Fax: 949-722-2481
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Oral and Maxillofacial Surgery

1223S0112X 19 Oral Surgery (Dentist only)
Indicates primary specialty

NPI Profile & details for GARY L WYATT · (Male)

NPI # 1003978602
Status Active
Credentials DDS (Doctor of Dental Surgery)
Entity Individual
Enumeration date 12/14/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • CA License # 22313
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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