Provider Demographics
NPI:1487877874
Name:T M WYLAND DENTAL LAB II INC
Entity type:Organization
Organization Name:T M WYLAND DENTAL LAB II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:BIDDLE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:814-946-8189
Mailing Address - Street 1:947 HALLOCK YOUNG RD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9636
Mailing Address - Country:US
Mailing Address - Phone:330-824-2515
Mailing Address - Fax:330-824-2333
Practice Address - Street 1:947 HALLOCK YOUNG RD SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-9636
Practice Address - Country:US
Practice Address - Phone:330-824-2515
Practice Address - Fax:330-824-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered292200000XLaboratoriesDental Laboratory