Provider Demographics
NPI:1538184361
Name:WYNN,III, WILLIAM B III (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:WYNN,III
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 N 2ND ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4657
Mailing Address - Country:US
Mailing Address - Phone:918-423-2208
Mailing Address - Fax:918-426-6722
Practice Address - Street 1:301 N 2ND ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4657
Practice Address - Country:US
Practice Address - Phone:918-423-2208
Practice Address - Fax:918-426-6722
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice