Basic Information
| Provider Information | |||||||||
| NPI: | 1639371289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUHST WYLIE | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488432325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175463180 | ||||||||
| FaxNumber: | 5175465824 | ||||||||
| Practice Location | |||||||||
| Address1: | 416 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488432325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175463180 | ||||||||
| FaxNumber: | 5175465824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 15032 | MI | Y | Dental Providers | Dentist |
No ID Information.