Provider Demographics
NPI:1427106640
Name:WIYGUL, MARK EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:WIYGUL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5340 POPLAR AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3516
Mailing Address - Country:US
Mailing Address - Phone:901-683-7771
Mailing Address - Fax:901-683-7772
Practice Address - Street 1:5340 POPLAR AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3516
Practice Address - Country:US
Practice Address - Phone:901-683-7771
Practice Address - Fax:901-683-7772
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDS41971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice