Provider Demographics
NPI:1427656503
Name:WYNN DENTAL CORPORATION
Entity type:Organization
Organization Name:WYNN DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIAL
Authorized Official - Phone:480-795-2420
Mailing Address - Street 1:16581 W BELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0004
Mailing Address - Country:US
Mailing Address - Phone:480-795-2420
Mailing Address - Fax:480-795-2553
Practice Address - Street 1:16581 W BELL RD STE 108
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-0004
Practice Address - Country:US
Practice Address - Phone:480-795-2420
Practice Address - Fax:480-795-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental