DR. GARY L WYATT (NPI# 1003978602) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003978602 |
| Entity Type | Individual |
| Full Name | DR. GARY L WYATT |
| Credential | DDS |
| Practice Address |
1801 Newport Boulevard Suite C Costa Mesa CA 92627 |
| Mailing Address |
1401 Avocado Avenue Suite 506 Newport Beach CA 92660 |
| Practice Telephone | 9496501030 |
| Practice Fax Number | 9497222481 |
| Mailing Telephone | 9497601661 |
| Mailing Fax Number | 9497608016 |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
22313 | CA | Dental Providers |
| Street Address |
1801 NEWPORT BOULEVARD SUITE C |
| City | COSTA MESA |
| State | CA |
| Zip Code | 92627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518029115 | Thomas R Michaelis | Dentist | 1801 Newport Boulevard, Suite C, Costa Mesa, CA 92627 | 2006-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407174 | Ryan Allen Merrell | Technician | 313 E. 17th Pl #l Costa Mesa, Costa Mesa, CA 92627 | 2020-11-04 |
| 1245703412 | Allure Transportation | Non-emergency Medical Transport (VAN) | 1835 Newport Blvd Ste 109 #110, Costa Mesa, CA 92627 | 2019-01-09 |
| 1750857686 | Living Success Center | Marriage & Family Therapist | 445 E. 17th Street, Suites D & E, Costa Mesa, CA 92627 | 2018-10-18 |
| 1790298909 | Akua Behavioral Health, Inc | Substance Abuse Rehabilitation Facility | 319-a University Drive, Costa Mesa, CA 92627 | 2017-11-09 |
| 1679086862 | Akua Behavioral Health, Inc | Substance Abuse Rehabilitation Facility | 319-b University Drive, Costa Mesa, CA 92627 | 2017-11-09 |
| 1245759018 | Surgical Assistant Associates | Clinic/Center | 186 E. 16th Street, Suite C, Costa Mesa, CA 92627 | 2017-09-13 |
| 1366962334 | Guadalupe A. Mejia Dental Corp. | Dentist | 700 W 19th St., Suite C, Costa Mesa, CA 92627 | 2017-06-21 |
| 1386189033 | Jian Yi Ye | Acupuncturist | 2488 Newport Blvd Ste B1, Costa Mesa, CA 92627 | 2017-01-04 |
| 1144764606 | Michele Marie Patton | Dental Hygienist | 2220 Fairview Rd., Costa Mesa, CA 92627 | 2016-12-18 |
| 1881148500 | Valerie Nguyen | Pharmacist | 1835 Newport Blvd # C, Costa Mesa, CA 92627 | 2016-08-10 |
| Find all providers in zip 92627 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518029115 | Thomas R Michaelis | Dentist | 1801 Newport Boulevard, Suite C, Costa Mesa, CA 92627 | 2006-12-14 |
| 1558812420 | Al Khateeb D.d.s Dental Corporation | Dentist | 267 E 17th St, Costa Mesa, CA 92627-3831 | 2016-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807979 | Ayed Hawatmeh Dds Inc | Dentist | 322 E Foothill Blvd, Pomona, CA 91767 | 2020-10-02 |
| 1114533064 | Alexander V. Antipov, D.d.s., Inc. | Dentist | 911 Reserve Drive, Suite 150, Roseville, CA 95678 | 2020-09-16 |
| 1609493170 | Amir Haghshenas Dds | Dentist | 3880 S Bascom Ave Ste 213, San Jose, CA 95124-2675 | 2020-07-01 |
| 1316568900 | Beech & Reid Dental Partnership | Dentist | 464 E Calaveras Blvd Ste B3, Milpitas, CA 95035-5412 | 2020-05-05 |
| 1518506773 | Francisco Suarez, Dds Inc. | Dentist | 4606 Hollywood Blvd Ste A, Los Angeles, CA 90027-5462 | 2020-01-04 |
| 1831748839 | Slate Dental Corporation | Dentist | 6512 Lonetree Blvd Ste 100, Rocklin, CA 95765-5883 | 2019-09-11 |
| 1255980140 | Dr Maloux Macasaet Saguin Dental Corporation | Dentist | 9800 Topanga Canyon Blvd Ste J, Chatsworth, CA 91311-4075 | 2019-09-04 |
| 1891342267 | Amrollahie and Riman Dental Partnership | Dentist | 1442 Irvine Blvd Ste 225, Tustin, CA 92780-3846 | 2019-08-21 |
| 1548821572 | Hoang Dental Corporation | Dentist | 1356 W Valley Pkwy Ste J, Escondido, CA 92029-2138 | 2019-06-20 |
| 1073173860 | Omfs Care Center Partners | Dentist | 215 N Fresno St Ste 490, Fresno, CA 93701-0000 | 2019-06-14 |
| Find all providers with the same taxonomy | ||||
| City | COSTA MESA |
| Zip Code | 92627 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.