Provider Demographics
NPI:1699725788
Name:WYGONSKI, ROBERT JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:WYGONSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 ATTUCKS LANE
Mailing Address - Street 2:STE 2-E
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-775-5676
Mailing Address - Fax:508-775-4163
Practice Address - Street 1:700 ATTUCKS LANE
Practice Address - Street 2:STE 2-E
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-775-5676
Practice Address - Fax:508-775-4163
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19609OtherDELTA DENTAL
19609OtherTUFTS MEDICAL
MAX07807OtherBCBS DENTAL MEDICAL GRP
1960950OtherCIGNA DENTAL
351151OtherUNITED HEALTH CARE DENTAL
554390OtherCIGNA MEDICAL
MAX11480OtherBCBS DENTAL MEDICAL GRP
043462388OtherTAX ID
280425OtherUS HEALTHCARE
3318505OtherTRI CARE MEDICAL
152228OtherHARVARD PILGRIM MEDICAL
MA19609OtherDENTAL LICENSE NUMBER
1672037OtherUNITED CONCORDIA DENTAL
2804025OtherAETNA
MA19609OtherDENTAL LICENSE NUMBER
351151OtherUNITED HEALTH CARE DENTAL