Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 11595 | NC |
NPI | 1003349614 |
---|---|
Provider Name | Dr. Jonathan Edward Wyble |
First Address | Asheville, NC 28806-3382 |
Second Address | Asheville, NC 28801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2017 |
Last Update Date | 06/11/2019 |