Provider Demographics
NPI:1427174556
Name:WYANT, C LEE (DDS)
Entity type:Individual
Prefix:
First Name:C
Middle Name:LEE
Last Name:WYANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16524 CHENAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5920
Mailing Address - Country:US
Mailing Address - Phone:501-821-4200
Mailing Address - Fax:501-821-2994
Practice Address - Street 1:16524 CHENAL PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5920
Practice Address - Country:US
Practice Address - Phone:501-821-4200
Practice Address - Fax:501-821-2994
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist