1699725788 NPI number — DR. ROBERT JOSEPH WYGONSKI DMD

Table of content: (NPI 1588607832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699725788 NPI number — DR. ROBERT JOSEPH WYGONSKI DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYGONSKI
Provider First Name:
ROBERT
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699725788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 ATTUCKS LANE
Provider Second Line Business Mailing Address:
STE 2-E
Provider Business Mailing Address City Name:
HYANNIS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-775-5676
Provider Business Mailing Address Fax Number:
508-775-4163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 ATTUCKS LANE
Provider Second Line Business Practice Location Address:
STE 2-E
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-775-5676
Provider Business Practice Location Address Fax Number:
508-775-4163
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  19609 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19609 . This is a "DELTA DENTAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19609 . This is a "TUFTS MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: X07807 . This is a "BCBS DENTAL MEDICAL GRP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1960950 . This is a "CIGNA DENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 351151 . This is a "UNITED HEALTH CARE DENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 554390 . This is a "CIGNA MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: X11480 . This is a "BCBS DENTAL MEDICAL GRP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043462388 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 280425 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3318505 . This is a "TRI CARE MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 152228 . This is a "HARVARD PILGRIM MEDICAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19609 . This is a "DENTAL LICENSE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1672037 . This is a "UNITED CONCORDIA DENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2804025 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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